Qutiapine Maret 2014

8/12/2019 Qutiapine Maret 2014

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Quetiapinein the long-term

treatment ofSchizophrenia

Tuti Wahmurti AS

ActivityID

75814/Exp.

March2015


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SCHIZOPHRENIA

Schizophrenia is more than a psychosis

Five symptoms dimension :

positive

negative

cognitive

affective

aggresive

The fact that a schizophrenia patients responsiveness to

antipsychotic treatment can change and lesson over the course ofillness ongoing neurodegenerative process ec excessive actionof glutamate ( exitotoxicity ).

Overlapping symptoms

Jones PB , Buckley PF , Schizophrenia , 2006


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Positive symptoms

Aggresive

symptoms

Assaultive

Verbally abusivePoor attention

Impaired executive

function

Anxiety, suicidality,

Depression, loss of

interest

Cognitive

symptomsAffective

symptoms

Negative symptoms

Delusions, hallucinations

Reduced speech and range of

emotions ; loss of interest , social

desire, sense of purpose /

motivation

Symptoms Overlap

Stahl SM. Stahls Essential Psychopharmacology : Neuroscientific Basis and Practical Application. 3rd ed. 2008.


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Affectivesymptoms

Positivesymptoms negative

symptoms

Aggresivesymptoms

Ventromedialprefrontal cortex

Orbitofrontalcortex

amygdala

mesolimbic

Mesocortcal /

prefrontal cortex

Nucleusaccumbersreward circuit

Dorsolateralprefrontal cortex

Localization of symptom domain



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100 %

50 %

0

15 20 40 60

apoptosis /necrosis

I II III IV

AGE

Stage of schizophrenia



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TREATMENT

Subsequent course of illness may be modulated by the timelines

and effectiveness of intervention with :

Antipsychotic psychotic symptoms / ( - )

Psychosocial interventions to rescue, conserve , promote

functioning.

Psychotherapy to improve adaptive mechanism and neuronal

system.

Lieberman JA , Murray RM, Comprehensive Care of Schizophrenia. 2001


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Positive symptom pharmacy



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Aggresive symptom pharmacy



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Negative symptom pharmacy



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Cognitive symptom pharmacy



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Metabolic pharmacy



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Sedation pharmacy



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FGAs vs SGAs

SGAs are replacing FGAs as first-line treatments in many countries

Tandon R & Jibson MD, 2003; Van Haren NE et al, 2006.

* Tolerability profiles of SGAs vary according to individual antipsychotic

Efficacy Tolerability

FGAs Positive symptoms

Relapse prevention

Extrapyramidal symptoms (EPS)

Tardive dyskinesia

Hyperprolactinaemia

SGAs*

Positive symptomsNegative symptoms

Cognitive symptoms

Mood symptoms

Relapse prevention

May provide neuroprotection

HyperglycemiaWeight gain


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Quetiapine XR 400, 600 and 800 mg

was compared with placebo and quetiapine

IR 800 mg

Faster dose escalation:

- 300 mg (Day 1)

- 400 or 600 mg (Day 2)

- 800 mg (Day 3)

Primary objective

Change from baseline in PANSS total

score at the end of treatment at Day 42(Week 6) (LOCF)

CGI-S=Clinical Global Impression-Severity; IR=immediate release; LOCF=last observation carried forward;

PANSS=Positive and Negative Syndrome Scale; XR=extended release.

Cutler AJ, et al. Psychopharmacol Bull 2010;43:37

69.

Clinical Trial 133 (6 weeks)

Overview


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Kasper S. Quetiapine is effective against anxiety and depressive symptoms in long-term treatment of patients with schizophrenia.

Depress Anxiety 2004, 20:44

7.

Quetiapine is efficacious in long-term relapse prevention

of schizophrenia

Quetiapine therapy (mean dose 472.4 mg) over 208 weeks successfully treated positive and negative

BPRS symptoms, CGI, and SANS scores,


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Effective in controlling depression

without leading to a manic or hypo manic state

in patients with schizophrenia

The study supports the effectivenessand tolerabilityof quetiapine

in reducing depressive symptoms in patients with schizophrenia

Lee et al. Efficacy and safety of quetiapine for depressive symptoms in patients with schizophrenia.

Hum. Psychopharmacol Clin Exp 2009; 24: 447

452.


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Quetiapine XR maintains remission status

Peuskens et al.. Long-term symptomatic remission of schizophrenia with once-daily extended release quetiapine fumarate:

post-hoc analysis of data from a randomized withdrawal, placebo-controlled study.

International Clinical Psychopharmacology 2010 (25):3

Once-daily quetiapine XR was effective in achieving symptomatic remission.

An important step towards functional recoveryand maintaining remission status

in the long-term treatment of patients with schizophrenia


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Quetiapine XR vs Risperidone

in the treatment of depressive symptoms

in schizophrenia or schizoaffective patients

Kasper et al. Extended release quetiapine fumarate (quetiapine XR) versus risperidone in the treatment of depressive symptoms

in schizophrenic or schizoaffective patients. Presented at the 19th EPA European Congress of Psychiatry, Vienna, Austria. 2011.


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Kim et al. Long-Acting Inectable Antipsyhcotics for First-Episode Schizophrenia: the Pros and Cons.

Hindawi Publishing Corporation Schizophrenia Research and Treatment.

Volume 2012, Article ID 560836, 8 pages. doi:10.1155/2012/560836


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THENEEDFORLONGTERMTREATMENT

The assumption : schizophrenia has a deterioring courseBut

Its course is life long challenges & opportunities

Patient need assisstance meeting a wide variety of needs.

1. Learning how to : - handle the tasks day-to-day living

- manage their psychotic symptoms

- get benefit from medication compliance.

2. Psychosocial interventions : short term & time limited strategies.

Social skills training , reducing stress.

Teaching how to cope with specific problems.

Discussing medical side effects.

Lieberman JA , Murray RM, Comprehensive Care of Schizophrenia. 2001


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