Efficacy and safety of olanzapine for treatment of patients with bipolar depression: Chinese subpopulation analysis of a double-blind, randomized, placebo-controlled study A review of aripiprazole in the treatment of patients with schizophrenia or bipolar I disorder Suicidal ideation and attempts among people with severe mental disorder, Addis Ababa, Ethiopia, comparative cross-sectional study Pimozide Augmentation of Clozapine Inpatients with Schizophrenia and Schizoaffective Disorder Unresponsive to Clozapine Monotherapy Spatial Working Memoryand Planning Ability: Contrasts between Schizophreniaand Bipolar i Disorder Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients. An open label follow-up study on amisulpride in the add-on treatment of bipolar I patients The Chinese First-Episode Schizophrenia Trial: background and study design. The European First Episode Schizophrenia Trial (EUFEST): Rationale and design of the trial First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents. Intramuscular olanzapine vs. intramuscular short-acting antipsychotics: safety, tolerability and the switch to oral antipsychotic medication in patients with schizophrenia or acute mania. Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST). Bipolar disorder, schizoaffective disorder, and schizophrenia overlap: a new comorbidity index. Prescribing for inpatients with schizophrenia: an international multi-center comparative study. Focus on aripiprazole: a review of its use in child and adolescent psychiatry. Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) Disorders. Baseline Striatal Functional Connectivity as a Predictor of Response to Antipsychotic Drug Treatment. Effects of a mutual support group for families of Chinese people with schizophrenia: 18-month follow-up. Cognitive effects of adjunctive N-acetyl cysteine in psychosis. Serum levels of brain-derived neurotrophic factor in patients with schizophrenia and bipolar disorder Cannabidiol in Humans—The Quest for Therapeutic Targets Is winter depression a bipolar disorder? Switching Patients with Stable Schizophrenia or Schizoaffective Disorder from Olanzapine to Risperidone Long-Acting Injectable Efficacy and safety of aripiprazole in the acute treatment of schizophrenia in Chinese patients with risperidone as an active control: a randomized trial. Divalproex monotherapy in the treatment of bipolar offspring with mood and behavioral disorders and at least mild affective symptoms. Frequency of hospitalisations and inpatient care costs of manic episodes Use of concomitant medication with antipsychotic treatment in outpatients with schizophrenia: Results from the European Schizophrenia Outpatients Health Outcomes (SOHO) study Quetiapine in bipolar disorder and cocaine dependence. Effectiveness and safety of olanzapine in the treatment of schizophrenia among Asian patients switching from conventional antipsychotics Randomized, placebo-controlled trial of risperidone for acute treatment of bipolar anxiety. Joint Analysis of Psychiatric Disorders Increases Accuracy of Risk Prediction for Schizophrenia, Bipolar Disorder, and Major Depressive Disorder Activation of mGlu2/3 receptors as a new approach to treat schizophrenia: a randomized Phase 2 clinical trial Effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care. Quetiapine for the continuation treatment of bipolar depression: naturalistic prospective case series from the Stanley Bipolar Treatment Network Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey
Background Depression in bipolar I disorder responds to the atypical antipsychotic olanzapine . This sub population analysis assessed whether olanzapine is superior to placebo specifically in the treatment of Chinese patients with bipolar I depression . Methods This was a sub population analysis of a 6-week , multicenter , double-blind , parallel , r and omized ,  placebo-controlled  trial among 12 Chinese study centers . Eligible in patients and out patients were r and omized to olanzapine ( 5 to 20 mg/day ) or placebo .  Patients were primarily assessed by the Montgomery-Åsberg Depression Rating Scale total score . Secondary assessment s used a range of other efficacy and safety measures . This sub population analysis was underpowered to show statistically significant differences between treatment groups . Results In total , 210 patients ( mean age 32.9 years at baseline , 54.3 % females ) were r and om-ized . Similar proportions of patients treated with olanzapine ( 75.0 % ) and placebo ( 72.9 % ) completed the double-blind phase . Baseline-to-endpoint least-squares mean ± st and ard error decrease in the Montgomery-Åsberg Depression Rating Scale total score in the olanzapine group ( −13.55±0.80 ) was similar to that noted in the parent trial ( −13.82±0.65 ) . However , the difference between olanzapine and placebo groups was not statistically significant ( P=0.44 ) ; this finding was also true for the secondary efficacy measures . A post hoc analysis showed a greater emergence of mania in the placebo group , which likely reduced the treatment difference between olanzapine and placebo in the primary efficacy measure . Safety data were consistent with the known safety profile of olanzapine , including a higher incidence of weight gain ( ≥7 % ) in the olanzapine group ( 24.1 % vs 1.4 % , P<0.001 ) . Conclusion Olanzapine provides similar improvement in depression among Chinese and non-Chinese bipolar I patients . The lack of a statistically significant difference between the olanzapine and placebo groups in this Chinese sub population analysis may relate to an a priori lack of study power , and underestimation of the effect of olanzapine because of a greater emergence of mania in placebo-treated patients and missing data associated with a high early discontinuation rate Aripiprazole has been approved by regulatory agencies for the treatment of schizophrenia and bipolar I disorder . Although it is a dopamine partial agonist , it also has substantial binding affinity for the serotonin 5HT2A receptor . Several double-blind r and omized clinical trials have established the efficacy and tolerability of aripiprazole within the dose range of 10–30 mg/day for schizophrenia , and 15–30 mg/day for manic or mixed states associated with bipolar I disorder . Relatively few comparative trials with other second-generation antipsychotics have been published for schizophrenia , with none available for bipolar disorder . The evidence so far suggests that in terms of efficacy for schizophrenia , aripiprazole is superior to placebo and haloperidol ( long term ) , similar to perphenazine and risperidone , and inferior to olanzapine .  Its tolerability profile in patients with schizophrenia appears superior to haloperidol , perphenazine , risperidone , and olanzapine .  Efficacy in treating manic or mixed states was established in placebo-controlled trials . Among some patients with bipolar disorder  , akathisia and gastrointestinal ( GI ) complaints can emerge at the start of treatment ; however , the GI symptoms were time-limited in many instances . Appropriate dosing may also be important in individualizing therapy to improve tolerability , with lower starting doses becoming more important when adding to , or switching from , another antipsychotic . Aripiprazole appears to have a low propensity for weight gain , a favorable metabolic profile , and no association with hyperprolactinemia Background People with severe mental disorders are associated with increased risk of suicide and suicide attempts compared to the general population . In low and middle-income countries , research concerning suicide attempts and completed suicide among people living with severe mental disorder is limited . The objective of this study was to assess suicide and attempts in people with severe mental disorder at Amanuel Mental Specialized Hospital , Addis Ababa , Ethiopia . Methods Institution-based cross-sectional study was conducted in August – September 2016 . Patients with schizophrenia and bipolar disorder were selected using systematic r and om-sampling technique . The composite international diagnostic interview was used to assess suicide that was administered by psychiatry professionals . Substance use disorder was assessed through face-to-face interviews using structured clinical interview of DSM-IV . Results A total of 542 ( 272 schizophrenia + 270 bipolar disorder ) patients were included in the study . One hundred nineteen ( 43.75 % ) of schizophrenic participants and 128 ( 47.1 % ) of bipolar participants have suicidal ideation . Fifty-six ( 20.7 % ) of schizophrenic participants and 58 ( 21.3 % ) of bipolar participants have suicidal attempt . Among the schizophrenic and bipolar patients who had suicidal ideation , 31.8 and 32.60 % had co-morbid substance use disorder , respectively . Conclusion In this study , which was performed in Ethiopia , suicidal ideation and attempt were shown to be common problems in people with schizophrenia and bipolar disorder . Co-morbid substance use disorder was a more frequent phenomenon among patients with suicidal ideation and attempt . Attention should be given to screen and assess suicidal ideation and attempt in persons with schizophrenia and bipolar disorder Despite its superior efficacy , clozapine is helpful in only a subset of patients with schizophrenia unresponsive to other antipsychotics . This lack of complete success has prompted the frequent use of various clozapine combination strategies despite a paucity of evidence from r and omized controlled trials supporting their efficacy . Pimozide , a diphenylbutylpiperidine , possesses pharmacological and clinical properties distinct from other typical antipsychotics . An open-label trial of pimozide adjunctive treatment to clozapine provided promising pilot data in support of a larger controlled trial . Therefore , we conducted a double-blind , placebo-controlled , parallel- design ed 12-week trial of pimozide adjunctive treatment added to ongoing optimal clozapine treatment in 53 patients with schizophrenia and schizoaffective disorder partially or completely unresponsive to clozapine monotherapy . An average dose of 6.48 mg/day of pimozide was found to be no better than placebo in combination with clozapine at reducing Positive and Negative Syndrome Scale total , positive , negative , and general psychopathology scores . There is no suggestion from this rigorously conducted trial to suggest that pimozide is an effective augmenting agent if an optimal clozapine trial is ineffective . However , given the lack of evidence to guide clinicians and patients when clozapine does not work well , more controlled trials of innovative strategies are warranted Working memory may be conceptualized as a multi-component system involving the active maintenance and manipulation of stored information in the service of planning/guiding behaviour . Impaired spatial working memory is a robust finding in schizophrenia patients which has been related to an impairment in frontostriatal connectivity . The purpose of this study was to examine the specificity of this impairment by comparing the mnemonic and executive aspects of working memory performance in schizophrenia and bipolar disorder with psychotic features , focusing particularly on the functional dynamics between task components . Twenty-four patients with schizophrenia , 14 patients with bipolar I disorder ( manic phase ) and 33 healthy control subjects were assessed using the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) : including the spatial working memory ( between search errors and strategy scores ) spatial span ( storage capacity ) and spatial planning ( Stockings of Cambridge : accuracy and latency ) tasks . Both patient groups were impaired on the spatial span task , which requires the maintenance and retrieval of stored information . In contrast , only schizophrenia patients showed a significant deficit in between search errors , which requires both maintenance and manipulation of information in working memory . That is , they exhibited both a mnemonic and an executive dysfunction . Spatial span was particularly important to accurate planning ability in bipolar patients . In contrast , in patients with schizophrenia  poor spatial working memory was a significant predictor of planning impairments , consistent with failures in goal selection , evaluation and /or execution . Furthermore , initial planning time was positively correlated with the latency to complete a planning sequence . This pattern of slow cognitive processing in schizophrenia patients only , resembled that reported previously in patients with basal ganglia disorders . These findings are discussed in terms of a possible common disturbance in fronto-parietal circuitry in the two disorders together with a specific disturbance of fronto-striatal circuitry in schizophrenia , that is not present in bipolar disorder OBJECTIVE To describe the Worldwide-Schizophrenia Outpatient Health Outcomes ( W-SOHO ) patient population at study entry , focusing on illness burden and prescribing practice s across regions . METHODS The SOHO study was a 3-year , prospect i ve , observational study design ed to assess costs and outcomes associated with antipsychotic use in out patients initiating or changing antipsychotic ( with an emphasis on olanzapine compared with other antipsychotics ) . SOHO was conducted in 10 European countries and 27 other countries as Intercontinental SOHO ( IC-SOHO ) . Data from all countries have been pooled to produce the W-SOHO data set . MAIN OUTCOMES MEASURES Clinical Global Impression-Schizophrenia ( CGI-SCH ) severity scores , psychotropic medication use , adverse events , social interaction , housing and employment status , self-perceived health state ( EuroQoL EQ-5D scale and Visual Analogue Scale , EQ-VAS ) , and reasons for initiation/change of antipsychotic . RESULTS The W-SOHO data base comprises 17,384 patients from six regions ; East Asia ( n = 1223 ) , Central and Eastern Europe ( n = 2175 ) , Northern Europe ( n = 4291 ) , Southern Europe ( n = 5788 ) , Latin America ( n = 2566 ) , North Africa and the Middle East ( n = 1341 ) . Overall , patients were 38 + /- 13 years old ( mean + /- SD ) , moderately ill ( mean CGI-SCH overall score of 4.4 + /- 1.0 ) with a median duration of illness of 7 years ( interquartile range 1 - 16 years ) ; 43 % were female , 10 % were receiving antipsychotic medication for the first time .  Adverse events were prevalent across all regions ; on average , 50 % ( range 41 - 59 % ) of patients taking antipsychotics exhibited extrapyramidal symptoms at baseline , and 62 % ( 34 - 67 % ) of patients reported sexual dysfunction in the previous month . On average , only 19 % ( 16 - 23 % ) of patients were in paid employment and as many as 69 % were living in dependent housing . CONCLUSIONS Despite inherent diversity in these patients and the health care systems supporting them , there are striking cross-regional similarities in baseline characteristics for most measures . Not all countries are represented ; regional comparisons may not be valid outside of the countries studied Background Atypical antipsychotics are widely used in the treatment of bipolar disorders .  Amisulpride is an atypical antipsychotic that has been proven to be effective in treatment of schizophrenia , major depressive disorder and , more recently , acute mania . At the moment , however , no study has assessed the effectiveness of this compound in maintenance therapy of bipolar disorders . The purpose of this study was to assess the long-term effectiveness of amisulpride in combination with st and ard treatments in patients with bipolar I disorder who have shown inadequate responses to ongoing st and ard therapies .  Methods The study enrolled fourteen bipolar I out patients , not responding to ongoing st and ard therapy .  Three patients discontinued treatment but 11 were followed-up for 11.7 ± 8.2 months before ( range 3–24 months ) and 5.2 ± 2.7 months after the introduction of amisulpride ( range 3–9 months ) . Relapse rates before and during treatment with amisulpride were calculated in accordance to an increase of 1 or more in Clinical Global Impressions Scale-Bipolar Version ( CGI-BP ) score that was accompanied by a change in therapy or to an exacerbation of the symptoms that required hospitalization . Results A statistically significant decrease in overall relapse rate was observed during the period of amisulpride therapy compared with months previous to the introduction of amisulpride . The relative risk of relapse in the absence of amisulpride therapy was 3.1 ( χ2 = 4.2 , P < 0.05 ) . Similarly , the rates of manic/mixed and depressive relapse were decreased but only manic episodes reached statistical significance ( RR = 5.3 , χ2 = 5.2 , P < 0.02 ) . Discussion and conclusion This open-label study suggests that long-term therapy with amisulpride may benefit patients by improving global symptoms of bipolar disorder and reducing the rate of manic/mixed relapses . Large , r and omized , double-blind , placebo-controlled studies are needed to explore the benefits of adding long-term amisulpride to st and ard therapies for bipolar disorder Schizophrenia is a complex illness with unknown aetiology and pathogenesis . Currently , a considerable number of patients with schizophrenia do not receive st and ardised and systematic treatment in China . In the past years , many controlled trials have been conducted in chronic schizophrenia . In contrast , research on first-episode schizophrenia is lacking . This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project -- a multicentre , r and omised , open-label clinical trial . A total of 600 first-episode schizophrenia patients were r and omly divided into 3 groups and treated with risperidone , aripiprazole , and olanzapine for 1 year . During the study period , only 1 medication change of the 3 antipsychotic medications was allowed BACKGROUND Most studies comparing second generation antipsychotics with classical neuroleptics have been conducted in more or less chronic schizophrenia patients . Such studies were usually conducted in highly selected sample s , and were generally design ed and financed by the manufacturer of the drug tested . These and other facts have stimulated discussion s regarding the effectiveness of the new generation of antipsychotics . AIMS The aim of the European First Episode Schizophrenia Trial ( EUFEST ) is to compare treatment with amisulpride , quetiapine , olanzapine and ziprasidone to a low dose of haloperidol in an unselected sample of first episode schizophrenia patients with minimal prior exposure to antipsychotics . METHODS 500 patients between the ages of 18 - 40 meeting DSM-IV criteria for schizophrenia , schizoaffective disorder or schizophreniform disorder are r and omly allocated to one year of treatment with one of the drugs under study . The primary outcome measure is retention in treatment , defined as time to discontinuation of study drug . Loss of retention can be the result of insufficient clinical effect , or lack of tolerability or acceptance . Secondary measures include changes in different dimensions of psychopathology , side effects , compliance , social needs , quality of life , substance abuse and cognitive functions . CONCLUSIONS At present , more than 400 patients have been recruited and r and omized in the following countries : Austria , Belgium , Bulgaria , Czech Republic , Germany , France , Israel , Italy , the Netherl and s , Pol and , Rumania , Spain , Sweden and Switzerl and : The study should be finished by the end of 2006 and it is expected that results will yield relevant clinical information with regard to the effectiveness of the second generation antipsychotics . This effort represents the first independently design ed trans-European schizophrenia treatment trial OBJECTIVES To review the evidence for efficacy and metabolic effects of atypical antipsychotics ( AAPs ) , and to propose a metabolic monitoring protocol for AAP use in children and adolescents . METHODS A PubMed search was performed to obtain all studies related to efficacy , metabolic side-effects , and monitoring in those less than 18 years of age . RESULTS There are no approved indications for AAP use in children and adolescents in Canada . Based on US Food and Drug Administration approvals and a review of r and omized controlled trials , we identified 7 indications for AAP use that target specific symptoms in youth including schizophrenia , bipolar I disorder , autism , pervasive developmental disorder , disruptive behaviour disorders ( including conduct disorder and ADHD ) , developmental disabilities and Tourette Syndrome . A wide range of metabolic effects including weight gain , increased waist circumference , dysglycemia , dyslipidemia , hypertension , elevated hepatic transaminases and prolactin levels have been reported . We have developed a proposal for metabolic monitoring that includes anthropometric measurements and laboratory testing at baseline and appropriate intervals thereafter . CONCLUSION There is an urgent need for national clinical practice guidelines that provide , not only appropriate treatment algorithms for AAP-use based on evidence , but also address metabolic monitoring and subsequent management of complications in this vulnerable population BACKGROUND This study compared the safety , tolerability and switch to oral medication in patients with bipolar disorder or schizophrenia who received intramuscular ( IM ) olanzapine or other IM antipsychotics for the treatment of acute agitation . METHODS Patients ( N = 2011 ) from 15 countries participated in this prospect i ve , observational , non-interventional study . In patients requiring treatment with at least one IM injection of a short-acting antipsychotic  were assessed at baseline and within 7 days after the first IM injection . Treatment groups comprised : ( i ) patients prescribed IM olanzapine at baseline ; and ( ii ) patients prescribed any other IM antipsychotic medication at baseline . Outcome measures included : treatment-emergent adverse events , concomitant psychotropic medication and the time taken to switch to oral medication . RESULTS Fewer patients in the IM olanzapine group experienced an adverse event than patients in the other IM antipsychotic group ( 34.4 % vs. 46.2 % , p < 0.001 ) . The most frequently reported adverse events in both groups were : sedation , Parkinsonism , disturbance in attention , akathisia , dystonia and orthostatic hypotension . Fewer patients in the IM olanzapine group used anticholinergics ( 13.9 % vs. 42.5 % , p < 0.001 ) or anxiolytics/hypnotics ( 47.6 % vs. 51.6 % , p = 0.023 ) . Patients in the IM olanzapine group switched to oral medication earlier than patients in the other IM antipsychotic group ( median time = 46.5 vs. 48.0 h , p = 0.009 ) . CONCLUSIONS These findings suggest that IM olanzapine may have a favourable impact on individual patients . However , the high rate of oral concomitant medication used throughout the study limits these findings from being associated with IM olanzapine alone OBJECTIVE To compare the effects of haloperidol , amisulpride , olanzapine , quetiapine , and ziprasidone on hostility in first-episode schizophrenia , schizoaffective disorder , or schizophreniform disorder . METHOD We used the data acquired in the European First-Episode Schizophrenia Trial , an open , r and omized trial ( conducted in 14 countries ) comparing 5 antipsychotic drugs in 498 patients aged 18 - 40 years with first-episode schizophrenia , schizoaffective disorder , or schizophreniform disorder . DSM-IV diagnostic criteria were used . Patients were assessed between December 23 , 2002 and January 14 , 2006 . Most subjects joined the study as in patients and then continued with follow-ups in outpatient clinic visits . The Positive and Negative Syndrome Scale ( PANSS ) was administered at baseline and at 1 , 3 , 6 , 9 , and 12 months after r and omization . We analyzed the scores on the PANSS hostility item in a subset of 302 patients showing at least minimal hostility ( a score > 1 ) at baseline . We hypothesized ( 1 ) that the treatments would differ in their efficacy for hostility and ( 2 ) that olanzapine would be superior to haloperidol . Our primary statistical analysis tested the null hypothesis of no difference among the treatment groups in change in hostility over time . Secondary analysis addressed the question of whether the effects on hostility found in the primary analysis were specific to this item . All our analyses were post hoc . RESULTS The primary analysis of hostility indicated an effect of differences between treatments ( F(4,889 ) = 4.02 , P = .0031 ) . Post hoc treatment-group contrasts for hostility change showed that , at months 1 and 3 , olanzapine was significantly superior ( P < .05 ) to haloperidol , quetiapine , and amisulpride in reducing hostility . Secondary analyses demonstrated that these results were at least partly specific to hostility . CONCLUSIONS Both hypotheses were supported . Olanzapine appears to be a superior treatment for hostility in early phases of therapy for first-episode schizophrenia , schizoaffective disorder , and schizophreniform disorder . This efficacy advantage of olanzapine must be weighed against its adverse metabolic effects and propensity to cause weight gain . TRIAL REGISTRATION IS RCT N Register Identifier : IS RCT N68736636 OBJECTIVE Growing evidence of an etiologic overlap between schizophrenia , schizoaffective disorder , and bipolar disorder has become increasingly difficult to disregard . We investigated the magnitude of the overlap between the clinical diagnoses of bipolar affective disorder , schizoaffective disorder , and schizophrenia over a 35-year period based on the entire Danish population . METHOD We established a  register-based prospect i ve cohort study of more than 2.5 million persons born in Denmark after 1954 . Risks for the 3 psychiatric disorders were estimated by survival analysis using the Aalen-Johansen method . Cohort members were followed from 1970 to 2006 . We introduced a new comorbidity index measuring the magnitude of the overlap between the 3 disorders . RESULTS Overall , 12,734 patients were admitted with schizophrenia , 4,205 with bipolar disorder , and 1,881 with schizoaffective disorder . A female bipolar patient 's risk of also being admitted with a schizoaffective disorder by the age of 45 years was approximately 103 times higher than that of a woman at the same age in the general population . Thus , we defined the comorbidity index between schizoaffective disorder and bipolar disorder at age 45 years to be 103 . At age 45 years , the index between schizophrenia and schizoaffective disorder was 80 and between schizophrenia and bipolar disorder was 20 . Similar large comorbidity indexes were found for men . CONCLUSIONS A large comorbidity index between schizophrenia and schizoaffective disorder was found , as well as a large index between bipolar disorder and schizoaffective disorder . But , more surprisingly , it was clear that a substantial comorbidity index between bipolar disorder and schizophrenia was present . This study supports the existence of an overlap between bipolar disorder and schizophrenia and thus challenges the strict categorical approach used in both DSM-IV and ICD-10 classification systems BACKGROUND This study compares prescription practice s for acute in patients with schizophrenia among six academic departments located in China , Japan , Hungary , and the U.S. METHODS Prescription data for a sample of 429 in patients from six academic departments were collected on a r and omly chosen census day . All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years . RESULTS While patients at the different centers varied in their demographic and clinical characteristics , i. e. , age , sex , and length of illness , a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied ( i. e. , number and dose antipsychotics , atypical and depot antipsychotics , other psychotropic drugs , multiple antipsychotics , and daily dose ) except antidepressant use . In most cases these differences persisted even after adjusting for demographic and clinical characteristics ( age , sex , and length of illness ) of the subjects . Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs , including anticholinergics , anticonvulsants , benzodiazepines , and non-benzodiazepine hypnotics .  Anticholinergic use was more common with typical antipsychotics . Rates of atypical antipsychotic drug use were lowest in the Japanese center . The Japanese center had by far the highest mean daily dose of antipsychotics .  CONCLUSIONS The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia . The results also confirm previous findings that prescribing practice s for schizophrenia vary greatly among centers and countries . A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs , such as anticholinergics , hypnotics , anticonvulsants , and benzodiazepines , administered in multiple daily doses OBJECTIVE To review published literature regarding aripiprazole in child and adolescent psychiatry . METHOD A literature review was conducted using the medline search term : ' aripiprazole ' with limits : Human trials , English language , All Child ( aged 0 - 18 years ) . Additional articles were identified from reference information and poster presentation data . RESULTS Aripiprazole is an atypical antipsychotic which was recently approved for use in Canada , but has been available for several years in the United States . Pharmacologically , aripiprazole is a partial agonist at D(2 ) and 5-HT(1A ) receptors and an antagonist at 5-HT(2A ) receptors . R and omized controlled trial data is available showing efficacy for aripiprazole in the treatment of children and adolescents with schizophrenia , bipolar disorder and behavioural problems associated with autism . Open-label evidence is also available for use of aripiprazole in other disorders such as tic disorders , aggression and disruptive behavior disorders . Unlike some other available atypical antipsychotics , there does not appear to be any effect on QTc interval on the electrocardiogram . Adverse effects including extrapyramidal symptoms ( EPS ) , akathisia , sedation , headache , nausea were significant in clinical trials in children and adolescents . The possibility of aripiprazole causing tardive dyskinesia can not be excluded . In this population , aripiprazole appears to have minimal impact on the metabolic profile compared to most other atypical antipsychotics , with minimal changes in weight or body mass index , no significant changes in glucose or lipid metabolism , and a decrease in serum prolactin . CONCLUSION Aripiprazole may represent an important alternative for some children and adolescents who have experienced poor efficacy or significant metabolic adverse effects with their current antipsychotic treatment regimen Treatment of bipolar disorder often results in patients taking several drugs in an attempt to alleviate residual depressive symptoms , which can lead to an accumulation of side effects . New treatments for bipolar depression that do not increase the side effect burden are needed . One nonpharmacological treatment with few side effects , bright light therapy , has been shown to be an effective therapy for seasonal affective disorder , yet has not been extensively studied for other forms of depression . Forty-four adults with bipolar disorder , depressed phase were r and omized to treatment with bright light therapy , low-density or high-density negative ion generator for 8 weeks . The primary measure of efficacy was the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement ( SIGH-ADS ) . Adverse events were assessed using the Young Mania Rating Scale ( YMRS ) and Systematic Assessment for Treatment Emergent effects ( SAFTEE ) . All outcome variables were statistically analyzed using a mixed model repeated measure analysis of variance ( ANOVA ) . The results showed no statistically significant differences between groups in any outcome measures at study end point ; adverse events , including switches into hypomania , were rare . Further research is needed to determine the efficacy of bright light therapy in this population OBJECTIVE Early , effective treatment in first-episode schizophrenia is advocated , although evidence based on a systematic approach over multiple antipsychotic trials is lacking . Employing a naturalistic design , we examined response rates over 3 circumscribed antipsychotic trials . METHOD Between June 2003 and December 2008 , 244 individuals with first-episode schizophrenia or schizoaffective disorder according to DSM-IV criteria were treated at the Centre for Addiction and Mental Health , Toronto , Ontario , Canada , following an algorithm that moved them through 2 antipsychotic trials , followed by a trial with clozapine . For the first 2 trials , treatment consisted of risperidone followed by olanzapine , or vice versa ; each trial consisted of 3 stages ( low- , full- , or high-dose ) lasting up to 4 weeks at each level and adjusted according to response/tolerability . Clinical response was defined as a Clinical Global Impressions-Improvement score of 2 ( much improved ) or 1 ( very much improved ) and /or a Brief Psychiatric Rating Scale Thought Disorder subscale score ≤ 6 . Data were analyzed retrospectively , and publication of anonymized clinical data was approved by the Research Ethics Board of the Centre for Addiction and Mental Health in May 2003 . RESULTS In trial 1 , 74.5 % of individuals responded , with rates significantly higher for olanzapine ( 82.1 % , 115/140 ) versus risperidone ( 66.3 % , 69/104 ; P = .005 ) . With trial 2 , response rate dropped dramatically to 16.6 % but again was significantly higher for olanzapine ( 25.7 % , 9/35 ) compared to risperidone ( 4.0 % , 1/25 ; P = .04 ) . Response rate climbed above 70 % once more , specifically 75.0 % ( 21/28 ) , in those individuals who agreed to a third trial with clozapine . CONCLUSIONS Results confirm a high response rate ( 75 % ) to initial antipsychotic treatment in first-episode schizophrenia . A considerably lower response rate ( < 20 % ) occurs with a second antipsychotic trial . Results here were specific to olanzapine and risperidone , suggesting clinical differences ( ie , olanzapine more effective than risperidone ) . A subsequent trial with clozapine is clearly warranted , although it remains unclear whether outcome would be further enhanced if it were used earlier in the treatment algorithm OBJECTIVES Data from the Australian National Study of Low Prevalence ( Psychotic ) Disorders were used to describe the clinical and sociodemographic profile of individuals with bipolar disorder , their levels of impairment and disability , and use of medication and treatment services .  METHODS A 1-month census of contacts with mental health services , private psychiatric and general practice s , as well as contact points in marginalized setting s , was conducted in a national catchment of 1.1 million adults . The census yielded 3,800 individuals who screened positive for psychosis , of whom a r and om sample of 980 were administered a comprehensive semi-structured interview schedule . Results are presented on 112 persons with an ICD-10 diagnosis of bipolar disorder . RESULTS Overall , 69.6 % of the 112 persons who met the ICD-10 criteria for bipolar disorder reported a recurrent episodic illness , 25.0 % had a chronic course without clear remissions , and 5.4 % had a single episode of mania . Assessed on a lifetime basis , suicidal ideation was common ( 78.6 % ) and levels of drug and alcohol abuse/dependence were high ( 32.1 % ) . The majority ( 84.8 % ) had had at least one contact with inpatient , outpatient or emergency services in the previous year . Those with serious impairment had levels of service utilization similar to the rest of the sample , but were more likely to report a poorer quality of life and unmet service needs . While the percentage experiencing social and occupational dysfunction was substantial and similar for both sexes , women appeared to be better integrated socially than men . Comparisons with schizophrenia patients within the same survey sample highlighted less chronic impairment but equal or greater utilization of services by bipolar patients . CONCLUSIONS Despite low levels of chronicity , the burden of social disablement associated with bipolar disorder is high . The data suggest a number of important gaps in the provision of services for this predominantly treated population OBJECTIVE Clinical response to antipsychotic drug treatment is highly variable , yet prognostic biomarkers are lacking . The authors recently demonstrated that successful antipsychotic drug treatment alters resting-state functional connectivity of the striatum . The goal of the present study was to test whether intrinsic striatal connectivity patterns provide prognostic information and can serve as a potential biomarker of treatment response to antipsychotic drugs . METHOD The authors used resting-state functional MRI ( fMRI ) to develop a prognostic index in a discovery cohort of 41 first-episode schizophrenia patients , then tested this index in an independent cohort of 40 newly hospitalized chronic patients with acute psychosis . In the discovery cohort , patients underwent  resting-state fMRI scanning at the initiation of r and omized controlled treatment with a second-generation antipsychotic . Whole-brain functional connectivity maps were generated for each subject from striatal seed regions . A stringent measure of clinical response was calculated that required sustained improvement over two consecutive study visits . Clinical response was entered into a survival analysis , and Cox regression was applied to the functional connectivity data . A striatal connectivity index was created , comprising functional connections of the striatum that predicted treatment response . This striatal connectivity index was tested on a generalizability cohort of patients with psychotic disorders who were hospitalized for an acute psychotic episode . RESULTS A total of 91 regions functionally connected with the striatum provided significant prognostic information . Connectivity in these regions was used to create a baseline striatal connectivity index that predicted response to antipsychotic treatment with high sensitivity and specificity in both the discovery and generalizability cohorts . CONCLUSIONS These results provide evidence that individual differences in striatal functional connectivity predict response to antipsychotic drug treatment in acutely psychotic patients . With further development , this has the potential to serve as a prognostic biomarker with clinical utility and to reduce the overall burden associated with psychotic illnesses BACKGROUND Family intervention in schizophrenia can reduce patient relapse and improve medication adherence , but few studies on this have involved a Chinese population . AIMS To examine the effects of a mutual support group for Chinese families of people with schizophrenia , compared with psychoeducation and st and ard care . METHOD R and omised controlled trial in Hong Kong with 96 families of out- patients with schizophrenia , of whom 32 received mutual support , 33 psychoeducation and 31 st and ard care .  The psychoeducation group included patients in all the sessions , the mutual support group did not . Intervention was provided over 6 months , and patient- and family-related psychosocial outcomes were compared over an 18-month follow-up . RESULTS Mutual support consistently produced greater improvement in patient and family functioning and caregiver burden over the intervention and follow-up periods , compared with the other two conditions . The number of readmissions did not decrease significantly , but their duration did . CONCLUSIONS Mutual support for families of Chinese people with schizophrenia can substantially benefit family and patient functioning and caregiver burden BACKGROUND Cognitive deficits are predictors of functional outcome in patients with psychosis . While conventional antipsychotics are relatively effective on positive symptoms , their impact on negative and cognitive symptoms is limited . Recent studies have established a link between oxidative stress and neurocognitive deficits in psychosis . N-acetylcysteine ( NAC ) , a glutathione precursor with glutamatergic properties , has shown efficacy on negative symptoms and functioning in patients with schizophrenia and bipolar disorder , respectively . However , there are few evidence -based approaches for managing cognitive impairment in psychosis . The present study aims to examine the cognitive effects of adjunctive NAC treatment in a pooled subgroup of participants with psychosis who completed neuropsychological assessment in two trials of both schizophrenia and bipolar disorder . METHOD A sample of 58 participants were r and omized in a double fashion to receive 2 g/day of NAC ( n = 27 ) or placebo ( n = 31 ) for 24 weeks . Attention , working memory and executive function domains were assessed . Differences between cognitive performance at baseline and end point were examined using Wilcoxon 's test . The Mann-Whitney test was used to examine the differences between the NAC and placebo groups at the end point . RESULTS Participants treated with NAC had significantly higher working memory performance at week 24 compared with placebo ( U = 98.5 , p = 0.027 ) . CONCLUSIONS NAC may have an impact on cognitive performance in psychosis , as a significant improvement in working memory was observed in the NAC-treated group compared with placebo ; however , these preliminary data require replication . Glutamatergic compounds such as NAC may constitute a step towards the development of useful therapies for cognitive impairment in psychosis There is evidence that major psychiatric discords such as schizophrenia ( SZ ) and bipolar disorder ( BD ) are associated with dysregulation of synaptic plasticity with downstream alterations of neurotrophins . Brain-derived neurotrophic factor ( BDNF ) is the most widely distributed neurotrophin in the central nervous system ( CNS ) , and performs many biological functions such as promoting the survival , differentiation , and plasticity of neurons . Variants in the BDNF gene increase the risk of SZ and bipolar disorder . Chronic administration of drugs used to treat SZ and BD , such as lithium , valproate , quetiapine , clozapine , and olanzapine , increases BDNF expression in rat brain . To examine serum BDNF , three groups of chronically medicated DSM-IV SZ patients , on treatment with clozapine ( n=27 ) , typical ( n=14 ) , and other atypical antipsychotics ( n=19 ) , 30 euthymic BD patients , and 26 healthy control had 5 ml blood sample s collected by venipuncture . Serum BDNF levels were significantly higher in SZ patients ( p<0.001 ) when compared to either controls or euthymic BD patients . Increased BDNF in SZ patients might be related to the course of illness or to treatment variables . Prospect i ve studies are warranted Cannabidiol ( CBD ) , a major phytocannabinoid constituent of cannabis , is attracting growing attention in medicine for its anxiolytic , antipsychotic , antiemetic and anti-inflammatory properties . However , up to this point , a comprehensive literature review of the effects of CBD in humans is lacking . The aim of the present systematic review is to examine the r and omized and crossover studies that administered CBD  to healthy controls and to clinical patients . A systematic search was performed in the electronic data bases PubMed and EMBASE using the key word “ cannabidiol ” . Both monotherapy and combination studies ( e.g. , CBD + ∆9-THC ) were included . A total of 34 studies were identified : 16 of these were experimental studies , conducted in healthy subjects , and 18 were conducted in clinical population s , including multiple sclerosis ( six studies ) , schizophrenia and bipolar mania ( four studies ) , social anxiety disorder ( two studies ) , neuropathic and cancer pain ( two studies ) , cancer anorexia ( one study ) , Huntington ’s disease ( one study ) , insomnia ( one study ) , and epilepsy ( one study ) . Experimental studies indicate that a high-dose of inhaled/intravenous CBD is required to inhibit the effects of a lower dose of ∆9-THC . Moreover , some experimental and clinical studies suggest that oral/oromucosal CBD may prolong and /or intensify ∆9-THC-induced effects , whereas others suggest that it may inhibit ∆9-THC-induced effects . Finally , preliminary clinical trials suggest that high-dose oral CBD ( 150–600 mg/d ) may exert a therapeutic effect for social anxiety disorder , insomnia and epilepsy , but also that it may cause mental sedation . Potential pharmacokinetic and pharmacodynamic explanations for these results are discussed Sixty-one winter depressive patients were evaluated for evidence of bipolar illness .  Using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version and the General Behavior Inventory , only nine ( 15 % ) could be considered bipolar . On prospect i ve evaluation of patients during the summer following winter depression , few showed signs of manic or hypomanic symptoms . Also , few patients had a family history of bipolar illness . When patients were asked to evaluate symptoms of winter depression , lack of energy was found to be the most prominent feature of the syndrome Abstract Background : Patients with schizophrenia or related disorders often switch antipsychotic therapy , most commonly due to lack of efficacy and side effects . The differences in anticipated efficacy and tolerability among atypical antipsychotics may drive switching behaviours . Switching to long-acting antipsychotics may improve adherence . Improving adherence is essential as relatively short medication gaps significantly increase the risk of schizophrenia hospitalizations . Long-term treatment with risperidone long-acting injectable ( RLAI ) , the first available long-acting atypical antipsychotic , versus oral atypical antipsychotics showed better adherence with RLAI .  Stable patients with schizophrenia or related disorders treated with a stable dose of antipsychotic showed improved efficacy when switched to flexible doses of RLAI . The most common reason for patients to switch from olanzapine to another antipsychotic is excessive weight gain . Metabolic dysfunction also occurs more commonly with olanzapine than with risperidone . Patients switching from olanzapine to risperidone experienced significant decreases in body weight , body mass index and triglyceride levels , whereas patients switching from risperidone to olanzapine experienced significant increases in body weight and triglyceride levels . The efficacy , tolerability and safety of RLAI in non-acute patients with schizophrenia or schizoaffective disorder previously treated with oral olanzapine  needs to be explored . Objective : The objective of this study was to evaluate the efficacy , tolerability and safety of switching from oral olanzapine to RLAI . Methods : This was a six-month , prospect i ve , multicentre , non-r and omized , single-arm , open-label trial . The trial evaluated non-acute adult patients with psychotic disorders treated with a stable olanzapine dose who required a treatment change . Three weeks after RLAI initiation , olanzapine was tapered off over 1 week or 3 weeks . Efficacy and safety measures included the Positive and Negative Syndrome Scale ( PANSS ) , the Clinical Global Impression-Severity ( CGI-S ) , Global Assessment of Functioning ( GAF ) and treatment-emergent adverse events ( TEAEs ) . Results : Among 96 patients analysed , significant endpoint efficacy changes versus baseline were observed for PANSS , CGI-S and GAF ( all p < 0.0001 ) . PANSS total score improvement was ≥20 % for 65.6 % of patients and ≥50 % for 31.3 % . TEAEs were similar in the 1- and 3-week taper groups ( 40.0 % and 46.5 % , respectively ) . TEAEs were generally mild ( 34.5 % ) or moderate ( 49.0 % ) in intensity . Conclusion : Switching non-acute patients with schizophrenia or schizoaffective disorder requiring a treatment change from a stable dose of oral olanzapine to RLAI improved psychiatric symptom control , functioning and patient treatment satisfaction . RLAI was generally well tolerated OBJECTIVE Asian population s may differ from other races in response to antipsychotics . Studies of aripiprazole in Asian population s are scarce . This study aim ed to investigate the efficacy , safety , and tolerability of aripiprazole in Chinese patients with acute schizophrenia or schizoaffective disorder . METHOD This 4-week , double-blind , r and omized , parallel study was conducted in 5 medical centers in Taiwan between March 2004 and January 2005 . A total of 83 patients with a primary DSM-IV diagnosis of schizophrenia or schizoaffective disorder were r and omly assigned ( with a r and omization ratio of 3:2 ) to 15 mg/day of aripiprazole ( N = 49 ) or 6 mg/day of risperidone ( N = 34 ) . Efficacy measures included the Positive and Negative Syndrome Scale ( PANSS ) total , positive , and negative scores and Clinical Global Impressions-Severity of Illness ( CGI-S ) and -Improvement scale scores . Extrapyramidal symptoms ( EPS ) , weight gain , serum prolactin level , QTc interval , and self-reported adverse events were assessed as measures of safety and tolerability . RESULTS Both the aripiprazole and risperidone groups showed statistical improvement from baseline in PANSS total , PANSS positive , PANSS negative , and CGI-S scores at study endpoint ( all p < .001 ) . Significant improvement was noted in the first week of treatment for both treatment groups . There were no significant differences in efficacy measures between treatment groups . Aripiprazole showed significantly less EPS liability as assessed by the Simpson-Angus Scale ( p < .005 ) and less serum prolactin level elevation ( p < .001 ) than risperidone . Both groups showed mild weight gain . No patients showed clinical ly significant QTc interval prolongation in this study . CONCLUSION Compared with risperidone 6 mg/day , aripiprazole 15 mg/day has comparable efficacy and favorable safety and tolerability profiles in the short-term treatment of Chinese patients with acute schizophrenia . In this group of Chinese patients , the overall response to aripiprazole did not differ from that of white patients . CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT00283179 BACKGROUND Offspring of parents with bipolar disorder , by virtue of their high-risk status for developing bipolar disorder , merit an investigation of the efficacy of treatment with mood stabilizers . Behavioral and mood difficulties in this population may represent prodromal forms of bipolar disorder . We studied the efficacy of divalproex in treating child and adolescent bipolar offspring with mood or behavioral disorders who did not yet meet criteria for bipolar I or II disorder . METHOD We studied 24 children aged 6 - 18 years ( mean = 11.3 years ; 17 boys/7 girls ) with at least 1 biological parent with bipolar disorder . Participants were diagnosed by the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia with at least 1 of the following DSM-IV disorders : major depressive disorder , dysthymic disorder , cyclothymic disorder , or attention-deficit/hyperactivity disorder . Subjects all had at least moderate affective symptoms ( 28-item Hamilton Rating Scale for Depression or Young Mania Rating Scale score > 12 ) . After a 2-week washout period , subjects were treated with divalproex for 12 weeks , titrated to achieve serum levels of 50 - 120 micro g/mL ( mean final dose = 821 mg/day ; mean final serum level = 79.0 micro g/mL ) . RESULTS One subject discontinued after 2 weeks due to continuation of symptoms . Of the remaining 23 subjects , 18 ( 78 % ) were considered responders by primary outcome criteria ( " very much improved " or " much improved " on the Clinical Global Impressions-Improvement scale ) . Divalproex was well tolerated with no discontinuations due to adverse effects . CONCLUSION Bipolar offspring with mood or behavioral disorders and at least mild affective symptoms may respond to divalproex treatment . Our study was limited by the open treatment , lack of a placebo group , and the heterogeneous nature of the sample . Controlled studies are warranted in the use of divalproex in symptomatic bipolar offspring Abstract Background : Bipolar disorder is a chronic illness that may involve multiple relapses and result in substantial psychosocial impairment . However , very few recent studies have investigated the economic burden of the disease . Objective : To assess the frequency of hospitalisation and the inpatient care costs associated with manic episodes in patients with bipolar I disorder in France . Method : A cost-of-illness study was conducted based on available data using a hospital payer perspective . The lifetime prevalence of manic episodes was estimated from published epidemiological data using a r and om-effects meta- analysis . Data were obtained by a computerised literature search using the main scientific and medical data bases . Additional epidemiological references were identified from published studies and textbooks . Data on frequency of hospitalisation and length of stay were collected from a large psychiatric university hospital . Data on unit costs for inpatient care were obtained from the accounting system of the largest hospital group in Paris , France for the year 1999 . Results : Extrapolating from international data on the average prevalence of bipolar I disorder , the proportion of rapid cycling patients and the average cycle duration , we estimated the annual number of manic episodes in patients with bipolar I disorder to be around 265 000 in France . Based on hospital data in Paris , the proportion of manic episodes that require hospitalisation was estimated to be around 63 % . The average length of stay was 32.4 days and the hospitalisation-related costs were estimated to be around 8.8 billion French francs ( € 1.3 billion ) [ 1999 values ] . Conclusion : Our study highlights the lack of medical and economic data on the frequency and hospitalisation-related costs of manic episodes in patients with bipolar I disorder in France . As the lifetime prevalence of bipolar I disorder may be as high as 3 % among adults , further studies are required in order to provide representative national data and to allow economic evaluations of costs related to bipolar I disorder in France Use of concomitant medications with antipsychotic agents in the treatment of schizophrenia is common but lacks a clear scientific rationale . We evaluated concomitant medication usage during the first 6 months of the prospect i ve , observational , European Schizophrenia Outpatient Health Outcomes ( SOHO ) study , examining its frequency , variation according to type of antipsychotic drug used , and impact on treatment tolerability . We also determined factors that were associated with concomitant medication use . The use of concomitant medications differed greatly among the countries participating in the SOHO study . The presence of depressive symptoms and being female were associated with the use of concomitant antidepressants . Certain antipsychotics were associated with less use of concomitant medications : significantly fewer olanzapine- , quetiapine- and clozapine-treated patients used concomitant anticholinergics or anxiolytics/hypnotics .  Patients using concomitant medications had an increased incidence of sexually related side effects and extrapyramidal side effects ( EPS ) at 6 months follow-up compared with patients not using concomitant medications . The results should be interpreted conservatively due to the observational design of SOHO OBJECTIVE Bipolar disorder is associated with the highest rates of substance abuse of any psychiatric illness . Therefore , treatments that stabilize mood and decrease drug use or cravings are of great interest . Atypical antipsychotics are in widespread use in patients with bipolar disorder . However , minimal data are available on their use in bipolar patients with comorbid substance abuse . METHODS Open-label , add-on , quetiapine therapy was examined for 12 weeks in 17 out patients with bipolar disorder and cocaine dependence . Subjects were evaluated with a structured clinical interview ; Hamilton Depression Rating ( HDRS ) , Young Mania Rating ( YMRS ) , Brief Psychiatric Rating ( BPRS ) scales ; and Cocaine Craving Question naire ( CCQ ) . Urine sample s and self-reported drug use were also obtained . Data were analyzed using a last observation carried forward method on all subjects given medication at baseline . RESULTS Significant improvement from baseline to exit was observed in HDRS , YMRS , BPRS and CCQ scores ( p < or = 0.05 ) . Dollars spent on cocaine and days/week of cocaine use decreased non-significantly , and urine drug screens did not change significantly from baseline to exit . Quetiapine was well tolerated , with no subjects to our knowledge discontinuing because of side-effects . CONCLUSIONS The use of quetiapine was associated with substantial improvement in psychiatric symptoms and cocaine cravings . The findings are promising and suggest larger controlled trials of quetiapine are needed in this population OBJECTIVES The objectives of this study were : ( 1 ) to investigate , in a clinical practice setting , the effectiveness of olanzapine in the treatment of schizophrenia among partially-responding , symptomatic Asian patients who switch from conventional antipsychotic treatment , ( 2 ) to assess the safety of olanzapine and ( 3 ) to assess the change in quality of life  in Asian patients with schizophrenia who switch to olanzapine .  METHODS Effectiveness , safety and quality of life were assessed in out patients with schizophrenia ( n=1267 ) who lacked symptomatic control with conventional antipsychotics and were switched to olanzapine therapy .  Data for this prospect i ve , observational study were collected for 12 months from Asian patients in China , Hong Kong , the Philippines , South Korea and Taiwan . RESULTS Significant clinical improvements ( P<0.05 ) were observed following 12 months of olanzapine treatment and 87.3 % of the subjects responded to treatment at endpoint ( i.e. Brief Psychiatric Rating Scale Total score reduced by > or = 30 % relative to baseline ; last observation carried forward ) . Abnormal involuntary movements ( mean change in Abnormal Involuntary Movement Scale : -3.20 , P<0.001 ) and quality of life were significantly improved in patients treated with olanzapine . However , some patients experienced significant weight gain ( 3.60+/-4.50 kg , P<0.001 ) with olanzapine treatment , relative to baseline . CONCLUSIONS This study shows that switching to olanzapine may be effective in improving symptoms , may be well-tolerated and may improve the quality of life  in Asian patients who are only partially responsive to treatment with conventional antipsychotics . The pragmatic design and naturalistic setting of this large study make the findings relevant for treating patients from some Asian countries in routine clinical practice BACKGROUND The treatment of bipolar disorder is often complicated by the presence of a co-occuring anxiety disorder . Although second generation antipsychotics are being used with increasing frequency in bipolar patients , their anxiolytic effects have not been well studied in this population . METHODS The anxiolytic effect of risperidone 0.5 - 4 mg/day was tested in an 8-week , double-blind , placebo-controlled , r and omized clinical trial in 111 patients with bipolar disorder and a co-occuring panic disorder or generalized anxiety disorder ( GAD ) . The primary outcome measure was the Clinician Global Improvement-21 Anxiety scale ( CGI-21 Anxiety ) . Secondary measures included the Hamilton Anxiety Scale ( HAM-A ) and the Sheehan Panic Disorder Scale . RESULTS On the last-observation-carried forward analysis of repeated measures analysis of variance ( ANOVA ) , risperidone was not more effective than placebo for the CGI-21 Anxiety score or the other anxiety outcome measures .  Risperidone was well tolerated , with only two patients withdrawing because of adverse events . LIMITATIONS The  risperidone treated group had more patients with mixed states and lifetime panic disorder at r and omization than the placebo group . The study was limited to 8 weeks and to individuals with bipolar and comorbid panic disorder or GAD . The results may not be applicable to risperidone as an add-on treatment to mood stabilizers , or to bipolar disorder comorbid with anxiety disorders other than panic disorder or GAD . CONCLUSIONS Risperidone monotherapy was not an effective anxiolytic for bipolar patients with comorbid panic disorder or GAD in doses of 0.5 - 4 mg/day over 8 weeks of treatment . The efficacy of other second generation antipsychotics and mood stabilizers on anxiety in patients with bipolar disorder and a co-occuring anxiety disorder should be investigated in double-blind , placebo-controlled studies Genetic  risk prediction  has several potential applications in medical research and clinical practice and could be used , for example , to stratify a heterogeneous population of patients by their predicted genetic risk . However , for polygenic traits , such as psychiatric disorders , the accuracy of risk prediction is low . Here we use a multivariate linear mixed model and apply multi-trait genomic best linear unbiased prediction for genetic risk prediction . This method exploits correlations between disorders and simultaneously evaluates individual risk for each disorder . We show that the multivariate approach significantly increases the prediction accuracy for schizophrenia , bipolar disorder , and major depressive disorder in the discovery as well as in independent validation data sets . By grouping SNPs based on genome annotation and fitting multiple r and om effects , we show that the prediction accuracy could be further improved . The gain in prediction accuracy of the multivariate approach is equivalent to an increase in sample size of 34 % for schizophrenia , 68 % for bipolar disorder , and 76 % for major depressive disorders using single trait models . Because our approach can be readily applied to any number of GWAS data sets of correlated traits , it is a flexible and powerful tool to maximize prediction accuracy . With current sample size , risk predictors are not useful in a clinical setting but already are a valuable research tool , for example in experimental design s comparing cases with high and low polygenic risk Schizophrenia is a chronic , complex and heterogeneous mental disorder , with pathological features of disrupted neuronal excitability and plasticity within limbic structures of the brain . These pathological features manifest behaviorally as positive symptoms ( including hallucinations , delusions and thought disorder ) , negative symptoms ( such as social withdrawal , apathy and emotional blunting ) and other psychopathological symptoms ( such as psychomotor retardation , lack of insight , poor attention and impulse control ) . Altered glutamate neurotransmission has for decades been linked to schizophrenia , but all commonly prescribed antipsychotics act on dopamine receptors . LY404039 is a selective agonist for metabotropic glutamate 2/3 ( mGlu2/3 ) receptors and has shown antipsychotic potential in animal studies . With data from rodents , we provide new evidence that mGlu2/3 receptor agonists work by a distinct mechanism different from that of olanzapine . To clinical ly test this mechanism , an oral prodrug of LY404039 ( LY2140023 ) was evaluated in schizophrenic patients with olanzapine  as an active control in a r and omized , three-armed , double-blind , placebo-controlled study . Treatment with LY2140023 , like treatment with olanzapine , was safe and well-tolerated ; treated patients showed statistically significant improvements in both positive and negative symptoms of schizophrenia compared to placebo ( P < 0.001 at week 4 ) . Notably , patients treated with LY2140023 did not differ from placebo-treated patients with respect to prolactin elevation , extrapyramidal symptoms or weight gain . These data suggest that mGlu2/3 receptor agonists have antipsychotic properties and may provide a new alternative for the treatment of schizophrenia BACKGROUND In two recent r and omised clinical trials , a meta- analysis and in an effectiveness study analysing routine data from the U.S. Veterans Administration the superiority of the newer atypical drugs over typical antipsychotic drugs , concerning both their efficacy and their side-effect profile , has been question ed . AIMS OF THE STUDY To analyse the effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care . METHODS Cohort study using routine care data from a statutory sickness fund with 5.4 million insured in Germany . To be included , patients had to be discharged with a diagnosis of schizophrenia in 2003 and fulfil membership criteria . Main outcome measures were rehospitalisation rates , mean hospital bed days , mean length of stay , cost of inpatient and pharmaceutical care to the sickness fund during follow-up and medication used to treat side-effects . RESULTS 3121 patients were included into the study . There were no statistically significant differences in the effectiveness of atypical and typical antipsychotics on rehospitalisation during follow-up ( rehospitalisation rate ratio 1.07 , 95 % confidence interval 0.86 to 1.33 ) . However , there were consistent observations of atypical antipsychotics being more effective for severe cases of schizophrenia ( 14.6 % of study population ; > 61 prior bed days per year in 2000 - 2002 ) in the follow-up period , whereas for the other severity strata typical antipsychotics seemed more effective in reducing various rehospitalisation outcomes .  Patients treated with atypical antipsychotics  received significantly less prescriptions for anticholinergics or tiaprid ( relative risk 0.26 , 95 % confidence interval 0.18 to 0.38 ) . DISCUSSION The effectiveness of atypical antipsychotics for schizophrenia on rehospitalisation measures appeared similar to that of typical antipsychotics . With the exception of severe cases , the higher costs for atypical antipsychotics were not offset by savings from reduced inpatient care . Major limitations include the lack of statistical power for subgroup analyses , the lack of clinical severity scale data and of life-course medical history data which both increase the risk of residual confounding by disease severity . CONCLUSIONS This study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care . IMPLICATION S FOR HEALTH CARE PROVISION AND USE From a clinical perspective , this study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care . IMPLICATION S FOR HEALTH POLICIES Routine data studies can yield valuable information for policy decision-makers on the costs and the effectiveness of pharmaceuticals in routine care , complementing efficacy data from r and omised clinical trials currently used for licensing and reimbursement decisions . IMPLICATION S FOR FURTHER RESEARCH The non-significant differences in the effectiveness of atypical compared to typical antipsychotics according to severity of disease should be investigated in a prospect i ve observational study or in a r and omised clinical trial Continuation treatment for bipolar disorder often consists of a mood stabilizer and a second-generation antipsychotic . Quetiapine has been shown to be an effective treatment for acute mania and acute bipolar depression , but there are limited data for its use in continuation treatment . This study examined the effectiveness of open-label adjunctive quetiapine therapy for continuation treatment in patients with bipolar disorder . Prospect ively collected life chart data from 63 out patients with bipolar disorders , most recent episodes depressed , manic , or cycling , who received adjunctive quetiapine therapy as part of st and ard acute treatment were analyzed . Patients had 4 or more weeks of prequetiapine baseline data and at least 2 weeks of quetiapine treatment with no other medication changes . Patients were grouped by baseline symptoms ; depression only , mania only , or both mania and depression ( cycling group ) . Owing to small mania and well groups ( n=4 ) , differences between depression and cycling groups were examined and mania and well groups excluded . Fifty-five patients were included in the analyses . The primary outcome measure was change in mood severity from baseline to change in treatment regimen , as measured by the NIMH Life Charting Method . Patients received adjunctive quetiapine for a mean of 122 ( SD=149 ) days . Both groups showed significant improvement in depression ratings and time spent depressed by week 10 . Both groups showed significant improvement in overall mood . No between-group differences in improvement were found . Adjunctive quetiapine may be useful as continuation treatment in bipolar population s with both pure depressive and cycling symptoms . Further controlled studies are warranted Background This study explored the effectiveness of family psycho-education in reducing patients ’ symptoms and on  family caregiver burden . Methods Seventy Iranian out patients with a diagnosis of schizophrenia disorder and their caregivers were r and omly allocated to the experimental ( n = 35 ) or control groups ( n = 35 ) . Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers . The psycho-educational program consisted of ten 90-min sessions held during five weeks ( two session in each week ) . Each caregiver attended 10 sessions ( in five weeks ) At baseline , immediately after intervention , and one month later . Vali date d tools were used to assess patients ’ clinical status and caregiver burden . Results Compared with the control group , the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later . Conclusions These results suggest that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families . Trial registration I RCT Number:138809122812 N1 BACKGROUND Strong evidence exists for an association between childhood trauma , particularly childhood sexual abuse , and hallucinations in schizophrenia . Hallucinations are also well-documented symptoms in people with bipolar affective disorder . AIMS To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder . METHOD A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive-behavioural therapy for bipolar affective disorder . The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy . Symptom data were collected by trained research assistants masked to the hypothesis . RESULTS A significant association was found between those reporting general trauma ( n=38 ) and auditory hallucinations . A highly significant association was found between those reporting childhood sexual abuse ( n=15 ) and auditory hallucinations . CONCLUSIONS The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation BACKGROUND In China and other middle-income countries , neuropsychiatric conditions are the most important cause of ill health in men and women , but efforts to scale up mental health services have been hampered by the absence of high- quality , country-specific data for the prevalence , treatment , and associated disability of different types of mental disorders . We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China . METHODS We used multistage stratified r and om sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China ; the sampling frame of 113 million individuals aged 18 years or older included 12 % of the adult population in China . 63 004 individuals , identified with simple r and om selection methods at the sampling sites , were screened with an exp and ed version of the General Health Question naire and 16,577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist . FINDINGS The adjusted 1-month prevalence of any mental disorder was 17.5 % ( 95 % CI 16.6 - 18.5 ) . The prevalence of mood disorders was 6.1 % ( 5.7 - 6.6 ) , anxiety disorders was 5.6 % ( 5.0 - 6.3 ) , substance abuse disorders was 5.9 % ( 5.3 - 6.5 ) , and psychotic disorders was 1.0 % ( 0.8 - 1.1 ) . Mood disorders and anxiety disorders were more prevalent in women than in men , and in individuals 40 years and older than in those younger than 40 years . Alcohol use disorders were 48 times more prevalent in men than in women . Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents . Among individuals with a diagnosable mental illness , 24 % were moderately or severely disabled by their illness , 8 % had ever sought professional help , and 5 % had ever seen a mental health professional . INTERPRETATION Substantial differences between our results and prevalence , disability , and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed , country-specific situation analyses before they scale up mental health services . FUNDING China Medical Board of New York , WHO , and Sh and ong Provincial Bureau of Health
Findings related to effectiveness ( treatment discontinuation , quality of life , and neurocognitive improvements ) were generally consistent with those observed in non-Chinese population s. No new safety signals specific for Chinese population s were raised for olanzapine .
Chinese and non-Chinese population s with schizophrenia or bipolar disorder treated with olanzapine display broadly similar responses .
BACKGROUND Despite the burden of schizophrenia and bipolar disorder in the Chinese population , country-specific data to guide practitioners regarding antipsychotic therapy are lacking .