Drug-Drug Interactions, Other Factors Can Affect Antipsychotic Treatment Regimens: Presented at ECNP

Inhibitors or inducers of the cytochrome (CY) P450 system may affect the metabolism and activity of antipsychotic drugs, according to a study presented September 13 at the 22nd European College of Neuropsychopharmacology (ECNP) Congress.

Pierre Chue, MD, Department of Psychiatry, University of Alberta, Edmonton, Alberta, and colleagues performed an evidence-based review of all relevant literature to identify and define possible drug-drug interactions (DDIs) and other factors that may influence patient response to drug treatment.

Comorbidities such as smoking, alcohol, other substance-abuse disorders, infections, and metabolic disorders complicate the pharmacological management of psychotic patients. Additional factors such as genetic polymorphisms and environmental interactions (eg, DDIs and drug-food interactions) also influence drug efficacy. The researchers noted that clinicians need to consider these factors and others, along with patients' unique characteristics, when determining treatment.

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Risks and benefits of antipsychotics in children and adolescents

Many of the psychiatric disorders observed in adults have their onset in childhood or adolescence. In fact some studies show that at least 20% of children and adolescents will fulfil a diagnostic criterion for a mental disorder before reaching adulthood. The presence of a major mental illness is certainly no less serious in children than in adults – in fact, childhood onset of several psychiatric disorders predicts a worse illness course. Early manifestations of mental disorders may substantially impact the child´s academic performance and achievement as well as his/her ability to develop age-appropriate social skills. Thus, appropriate identification and treatment of signs and symptoms of psychiatric illnesses during childhood and adolescence is critical for minimizing continued or additional psychiatric problems that put these children at risk later in life.

For many years old antipsychotics have been used for the treatment of conditions such as severe conduct disorders, Tourette syndrome, bipolar disorder and schizophrenia in children and adolescents. Treatment advances, particularly with the introduction of new-generation antipsychotic medications, have created a lot of expectations in the search for long-term, clinically effective treatments for this young population. The prescription of new-generation antipsychotics has become a widely accepted practice in the treatment of children and adolescents with psychotic disorders (Armenteros & David, 2006) and many other psychiatric conditions (Findling et al., 2005; Olfson et al., 2006). In fact, prescribing of new-generation antipsychotics has increased dramatically in recent years in the paediatric population (160% in the USA between 1990 and 2000) (Patel et al., 2005).

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Olanzapine Long-Acting Injection (LAI) Data Presented at First Annual Schizophrenia International Research Society Conference

Results from olanzapine )long-acting injection (LAI) clinical trials showed that the efficacy and safety profile of olanzapine LAI was generally consistent with that of Zyprexa(R) (olanzapine) with the exception of injection-related events. Results from a 24-week maintenance study (HGKA) and interim findings from an ongoing open-label study (HGKB) were presented at the first annual Schizophrenia International Research Society (SIRS) Conference in Venice, Italy.

Olanzapine LAI is an investigational formulation that combines olanzapine with a pamoate salt, resulting in an extended delivery of up to four weeks. Since olanzapine was introduced in 1996, it has been prescribed to approximately 24 million people worldwide.

"These studies offer insight into the potential of olanzapine LAI as a maintenance treatment for patients with schizophrenia who may have difficulty taking medication on a daily basis," said David McDonnell, M.D., clinical research physician at Lilly. "Schizophrenia is a challenging and complex disease to manage, which is why finding new ways to support patient compliance with medication is so important."

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Clozapine Better Than "High-Dose" Olanzapine for the Treatment of Adolescents With Schizophrenia

The results of a 12-week, double-blind, randomised study published in the March issue of Biological Psychiatry suggest that clozapine is more effective than "high-dose" olanzapine for the treatment of children and adolescents with schizophrenia who do not respond to standard, first-line antipsychotic treatment.

There is a wealth of scientific literature available on the treatment of adults with schizophrenia. However, there is a paucity of data to guide the treatment of children and adolescents with schizophrenia.

"Although the US Food and Drug Administration has recently approved the use of aripiprazole and risperidone for adolescents with schizophrenia, few controlled data are available to help guide clinicians regarding the management of children and adolescents with schizophrenia who fail to respond to these standard 'first-line' antipsychotic treatments," according to Dr. Sanjiv Kumra, University of Minnesota, Minneapolis, Minnesota, one of the authors of the study.

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