Rationale
Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced ...sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied.
Objectives
To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life.
Methods
We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed.
Results
Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (
B
= 0.417;
p
= 2.1e − 6,
R
2
= 0.156) and nocturnal CIS (
B
= 0.411;
p
= 7.7e − 6,
R
2
= 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life.
Conclusions
The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended.
Trial registration
Clinical Trials (
https://clinicaltrials.gov
) under reference NCT04197037.
El abandono de las prácticas agro-ganaderas tradicionales en las áreas montañosas de la cuenca mediterránea está a menudo asociado a un incremento general de la masa vegetal y a una pérdida de ...ambientes abiertos. Los espacios protegidos de montaña de la red LTER (Long Term Ecological Research) son zonas privilegiadas para estudiar en detalle este proceso mediante proyectos de seguimiento de las poblaciones a largo plazo. En el caso particular del nódulo LTER-Montseny el impacto de la reforestación en las aves está siendo monitoreado gracias a la implantación, hace ya más de una década, del programa de seguimiento de aves comunes en Cataluña. Este programa de seguimiento está permitiendo desarrollar indicadores que determinan la evolución de las comunidades de aves de medios abiertos y de los bosques de este parque natural. En este trabajo se emplean indicadores multiespecíficos basados en la media geométrica de índices poblacionales anuales para determinar los cambios están sufriendo las aves de estos ambientes. Los resultados muestran que en el periodo 2002-2014 el impacto de la reforestación está siendo notable para las poblaciones de aves de medios abiertos (decremento poblacional del 44% entre 2002 y 2014). En consonancia con estos resultados, los gestores del parque han impulsado medidas de recuperación de los pastizales del parque conjuntamente con los agentes socieconómicos locales.
Abstract
Introduction
Long-acting injectable antipsychotics (LAIs) are associated with multiple positive outcomes in psychosis, but it is unclear whether LAIs are associated with worse outcomes if ...neuroleptic malignant syndrome (NMS), a potentially lethal adverse effect, occurs.
Methods
We used nationwide and nationally representative databases of healthcare encounters in Finland to study the incidence and outcome predictors of NMS in patients diagnosed with schizophrenia/schizoaffective disorder between January 01, 1972 and December 31, 2017. Using a nested case-control design, we also explored differences by antipsychotic formulation (LAI vs oral antipsychotic OAP) and class (first-generation antipsychotic FGA vs second-generation antipsychotic SGA).
Results
One hundred seventy-two NMS cases and 1441 sex-, age-, and diagnosis-matched controls were included (age = 58.8 ± 13.1 years, males = 59.9%). Incidence of NMS was 1.99 (1.98–2.00) per 10 000 person-years. The likelihood of developing NMS did not differ by antipsychotic formulation (adjusted odds ratio aOR: 0.89, 95% confidence intervals 95% CI: 0.59–1.33, for LAIs vs OAPs) or class (FGA-OAP vs SGA-OAP aOR: 1.08, 95% CI: 0.66–1.76, FGA-LAI aOR: 0.89, 95% CI: 0.52–1.53, SGA-LAI aOR: 1.35, 95% CI: 0.58–3.12). NMS risk factors included antipsychotic treatment change: increased number (odds ratios OR: 5.00, 95% CI: 2.56–9.73); decreased number/switch (OR: 2.43, 95% CI: 1.19–4.96); higher antipsychotic dose (>2DDDs–OR: 3.15, 95% CI: 1.61–6.18); co-treatment with anticholinergics (OR: 2.26, 95% CI: 1.57–3.24), lithium (OR: 2.16, 95% CI: 1.30–3.58), benzodiazepines (OR: 2.02, 95% CI: 1.44–3.58); and comorbid cardiovascular disease (OR: 1.73, 95% CI: 1.22–2.45). Within 30 days, 4.7% of cases with NMS died (15.1% within 1 year) without differences by antipsychotic formulation. NMS reoccurred in 5 of 119 subjects (4.2%), after a median = 795 (range = 77–839) days after rechallenge with antipsychotics.
Conclusion
NMS remains a potentially life-threatening risk, yet these results should further contribute to mitigate concerns about LAI safety regarding NMS onset or outcomes, including mortality.
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