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Focusing On Drug Versus Disease Mechanisms And On Clinical Subgrouping To Advance Personalised Medicine In Psychiatry, Jose De Leon

Psychiatry Faculty Publications

Personalised medicine has finally been featured in psychiatric journals, but psychiatrists have mainly focused on the promise of using disease mechanisms to personalise treatment. Psychiatric disorders such as schizophrenia and depression are not diseases, in the medical sense, and are probably more like syndromes. Instead of spending much time and effort focusing on the mechanisms of diseases that may instead be syndromes, the author believes that psychiatrists should (1) learn more about personalising prescription via drug mechanisms, a pharmacological approach to personalised medicine; and (2) reconsider prior attempts by traditional clinical psychopharmacologists to use sophisticated clinical approaches that try to …

Qt Interval Prolongation Associated With Intramuscular Ziprasidone In Chinese Patients: A Case Report And A Comprehensive Literature Review With Meta-Analysis, Xian-Bin Li, Yi-Lang Tang, Wei Zheng, Chuan-Yue Wang, Jose De Leon

Psychiatry Faculty Publications

Intramuscular (IM) ziprasidone has been associated with QTc interval prolongations in patients with preexisting risk factors. A 23-year-old male Chinese schizophrenia patient experienced an increase of QTc interval of 83 milliseconds (ms) after receiving 20 mg IM ziprasidone (baseline and increased QT/QTc were, respectively, 384/418 and 450/501). This was rated as a probable adverse drug reaction (ADR) by the Liverpool ADR causality assessment tool. A systematic review including all types of trials reporting the effect of IM ziprasidone on the QTc interval prolongation identified 19 trials with a total of 1428 patients. Mean QTc change from baseline to end of …

Pharmacokinetic And Pharmacodynamic Interactions Between Antiepileptics And Antidepressants, Domenico Italiano, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

INTRODUCTION: Antiepileptic-antidepressant combinations are frequently used by clinicians; their pharmacokinetic (PK) and pharmacodynamic (PD) drug interactions (DIs) have not been well studied but are frequently likely to be clinically relevant.

AREAS COVERED: This article provides a comprehensive review of PK DIs between antiepileptics and antidepressants. In the absence of PD DI studies, PD information on pharmacological mechanisms and studies on efficacy and safety of individual drugs are reviewed.

EXPERT OPINION: The clinical relevance of the inductive properties of carbamazepine, phenytoin, phenobarbital and primidone and the inhibitory properties of valproic acid and some antidepressants are well understood; correction factors are provided …

Paradoxes Of Us Psychopharmacology Practice In 2013: Undertreatment Of Severe Mental Illness And Overtreatment Of Minor Psychiatric Problems, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

False Negative Studies May Systematically Contaminate The Literature On The Effects Of Inducers In Neuropsychopharmacology. Part Ii: Focus On Bipolar Disorder, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Dsm-5 And Research Domain Criteria: One Hundred Years After Jaspers’ General Psychopathology, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Management Of Suicidal Behavior: Is The World Upside Down?, Paula Artieda-Urrutia, Isabel Parra Uribe, Gema Garcia-Pares, Diego Palao, Jose De Leon, Hilario Blasco-Fontecilla

Psychiatry Faculty Publications

No abstract provided.

Clinically Relevant Interactions Between Newer Antidepressants And Second-Generation Antipsychotics, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

INTRODUCTION: Combinations of newer antidepressants and second-generation antipsychotics (SGAs) are frequently used by clinicians. Pharmacokinetic drug interaction (PK DI) and poorly understood pharmacodynamic (PD) drug interaction (PD DI) can occur between them.

AREAS COVERED: This paper comprehensively reviews PD DI and PK DI studies.

EXPERT OPINION: More PK DI studies are needed to better establish dose correction factors after adding fluoxetine and paroxetine to aripiprazole, iloperidone and risperidone. Further PK DI studies and case reports are also needed to better establish the need for dose correction factors after adding i) fluoxetine to clozapine, lurasidone, quetiapine and olanzapine; ii) paroxetine to …

False-Negative Studies May Systematically Contaminate The Literature On The Effects Of Inducers In Neuropsychopharmacology. Part I: Focus On Epilepsy, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.

Pharmacogenomics In Psychiatry: From Therapeutic Drug Monitoring To Genomic Medicine, Séverine Crettol, Jose De Leon, Christoph Hiemke, Chin B. Eap

Psychiatry Faculty Publications

Psychiatry is increasingly combining new pharmacogenomic findings with therapeutic drug monitoring (TDM) to improve the safety and efficacy of pharmacotherapy. However, a distinction should be made between “nice to know” and “need to know” pharmacogenomic data because many results are statistically significant in meta-analyses but are not clinically relevant due to their low effect sizes. Some examples will illustrate this integration.

One Hundred Years Of Limited Impact Of Jaspers’ General Psychopathology On Us Psychiatry, Jose De Leon

Psychiatry Faculty Publications

Jaspers, a German psychiatrist, published General Psychopathology in 1913. Jaspers, Schneider, and Mayer-Gross were members of the Heidelberg school. General Psychopathology, indirectly through Schneider’s and Mayer-Gross’ textbooks and directly by its English translation in 1963, led to a narrow set of schizophrenia criteria in the United Kingdom. General Psychopathology had very limited direct impact on US psychiatry, which adopted a broader schizophrenia definition. The difference between UK and US schizophrenia was a key element in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, and the neo-Kraepelinian revolution. General Psychopathology contains two essential interrelated ideas: a) psychiatry is …

The Old And The New Eastern State Hospital In Lexington, Kentucky, Jose De Leon, Shane Shoemaker, Allen Brenzel

Psychiatry Faculty Publications

No abstract provided.

Are Major Repeater Patients Addicted To Suicidal Behavior?, Hilario Blasco-Fontecilla, Paula Artieda-Urrutia, Nuria Berenguer-Elias, Juan Manuel Garcia-Vega, Monica Fernandez-Rodriguez, Cesar Rodriguez-Lomas, Isabel Gonzalez-Villalobos, Luis Iruela-Cuadrado, Jose De Leon

Psychiatry Faculty Publications

The literature provides support for the hypothesis that some major repeaters (individuals with >=5 lifetime suicide attempts) are addicted to suicidal behavior (SB). This study explores whether major repeaters are addicted to SB or not using 7 criteria: tolerance (Criterion 1), withdrawal (Criterion 2), loss of control (Criterion 3), problems in quitting/cutting down (Criterion 4), much time spent using (Criterion 5), substantial reduction in activities (Criterion 6), and adverse physiological/physical consequences (Criterion 7). Total dependence on SB was indicated by the presence of 3 or more of the 7 criteria in the last 12 months. This cross-sectional study at Puerta …

Trajectories Of Symptom Dimensions In Short-Term Response To Antipsychotic Treatment In Patients With A First Episode Of Non-Affective Psychosis, J. M. Pelayo-Terán, Francisco J. Diaz, R. Pérez-Iglesias, P. Suárez-Pinilla, R. Tabarés-Seisdedos, Jose De Leon, B. Crespo-Facorro

Psychiatry Faculty Publications

Background Trajectory patterns of positive, disorganized and negative dimension symptoms during antipsychotic treatment in drug-naive patients with first-episode psychosis have yet to be examined by using naturalistic data.

Method This pragmatic clinical trial randomized 161 drug-naive patients with a first episode of psychosis to olanzapine, risperidone or haloperidol. Patients were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and Positive Symptoms (SAPS) at baseline and at the end of weeks 1, 2, 3, 4 and 6 of antipsychotic treatment. Censored normal models of response trajectories were developed with three dimensions of the SAPS-SANS scores (positive, disorganized and …

A Post-Dsm-Iii Wake-Up Call To European Psychiatry, Jose De Leon

Psychiatry Faculty Publications

No abstract provided.