EPA: European Congress of Psychiatry 2016

MADRID – Elderly patients who develop dementia often are on an antidepressant when dementia is diagnosed, and unexpectedly antidepressant use during the 3 years preceding diagnosis of dementia was linked with a significantly reduced mortality risk, Dr. Daniela Enache reported at the meeting, sponsored by the European Psychiatric Association.

Elderly Swedish patients who took an antidepressant for at least 1 year during the 3 years prior to their dementia diagnosis had a 13% relative reduction in mortality, compared with similar new-dementia patients who had not been on an antidepressant. The researchers tracked mortality for a median of 2.1 years following dementia diagnosis in 20,050 Swedes with a new dementia diagnosis using records from 2007-2013, said Dr. Enache, a psychiatrist and neurogeriatics researcher at the Karolinska Institute in Stockholm. The analysis adjusted for differences in age, sex, mental state, number of drugs used, and living conditions.

Mitchel L. Zoler/Frontline Medical News

The protective effect from 3 years of antidepressant use was strongest in people who went on to develop Alzheimer’s disease, the most common form of dementia in the study affecting 36% of all people who developed dementia. The findings also documented the relatively frequent antidepressant use by elderly people who develop dementia. In the series of people with newly diagnosed dementia of any type, 25% were on an antidepressant at the time of their dementia diagnosis, and 4,325 (22%) had used an antidepressant at least once during the 3 years prior to their diagnosis; 1,128 (6%) of the people diagnosed with dementia had used an antidepressant during all 3 years preceding their diagnosis.

Dr. Enache admitted that it was not clear why antidepressant treatment would have this mortality effect. One possibility is that the mortality benefit came from the action of antidepressants on behavioral symptoms. Or antidepressants could have a biological effect, such as reducing production of amyloid beta or affecting neurogenesis and brain plasticity. A third possibility is that antidepressant use is a marker for overall better health care.

Whatever the explanation, the finding provides reassurance that antidepressant treatment is safe in elderly patients who are at risk of developing dementia, she noted. And patients newly diagnosed with dementia should be screened for depression, although Dr. Enache stressed that antidepressants can be prescribed for other reasons, such as anxiety or behavior problems.

All types of antidepressants had this mortality effect: tricyclics, selective serotonin reuptake inhibitors, and other types. Use of antidepressants was roughly similar across various dementia diagnoses, ranging from 22% of patients with mixed dementia and 23% of those with Alzheimer’s disease to a high of 32% among patients with Parkinson’s disease dementia.

The researchers used data collected in the national Swedish Dementia Registry, which includes about 90% of patients treated at Swedish memory clinics, along with data from the national Prescribed Drug Registry. The average age at time of dementia diagnosis was 78 years. Following Alzheimer’s disease, the other most common diagnoses were mixed dementia, in 25%, and vascular dementia, in 19%.

Dr. Enache had no disclosures.

MADRID – Elderly patients who develop dementia often are on an antidepressant when dementia is diagnosed, and unexpectedly antidepressant use during the 3 years preceding diagnosis of dementia was linked with a significantly reduced mortality risk, Dr. Daniela Enache reported at the meeting, sponsored by the European Psychiatric Association.

Elderly Swedish patients who took an antidepressant for at least 1 year during the 3 years prior to their dementia diagnosis had a 13% relative reduction in mortality, compared with similar new-dementia patients who had not been on an antidepressant. The researchers tracked mortality for a median of 2.1 years following dementia diagnosis in 20,050 Swedes with a new dementia diagnosis using records from 2007-2013, said Dr. Enache, a psychiatrist and neurogeriatics researcher at the Karolinska Institute in Stockholm. The analysis adjusted for differences in age, sex, mental state, number of drugs used, and living conditions.

Mitchel L. Zoler/Frontline Medical News

The protective effect from 3 years of antidepressant use was strongest in people who went on to develop Alzheimer’s disease, the most common form of dementia in the study affecting 36% of all people who developed dementia. The findings also documented the relatively frequent antidepressant use by elderly people who develop dementia. In the series of people with newly diagnosed dementia of any type, 25% were on an antidepressant at the time of their dementia diagnosis, and 4,325 (22%) had used an antidepressant at least once during the 3 years prior to their diagnosis; 1,128 (6%) of the people diagnosed with dementia had used an antidepressant during all 3 years preceding their diagnosis.

Dr. Enache admitted that it was not clear why antidepressant treatment would have this mortality effect. One possibility is that the mortality benefit came from the action of antidepressants on behavioral symptoms. Or antidepressants could have a biological effect, such as reducing production of amyloid beta or affecting neurogenesis and brain plasticity. A third possibility is that antidepressant use is a marker for overall better health care.

Whatever the explanation, the finding provides reassurance that antidepressant treatment is safe in elderly patients who are at risk of developing dementia, she noted. And patients newly diagnosed with dementia should be screened for depression, although Dr. Enache stressed that antidepressants can be prescribed for other reasons, such as anxiety or behavior problems.

All types of antidepressants had this mortality effect: tricyclics, selective serotonin reuptake inhibitors, and other types. Use of antidepressants was roughly similar across various dementia diagnoses, ranging from 22% of patients with mixed dementia and 23% of those with Alzheimer’s disease to a high of 32% among patients with Parkinson’s disease dementia.

The researchers used data collected in the national Swedish Dementia Registry, which includes about 90% of patients treated at Swedish memory clinics, along with data from the national Prescribed Drug Registry. The average age at time of dementia diagnosis was 78 years. Following Alzheimer’s disease, the other most common diagnoses were mixed dementia, in 25%, and vascular dementia, in 19%.

Dr. Enache had no disclosures.

MADRID – Elderly patients who develop dementia often are on an antidepressant when dementia is diagnosed, and unexpectedly antidepressant use during the 3 years preceding diagnosis of dementia was linked with a significantly reduced mortality risk, Dr. Daniela Enache reported at the meeting, sponsored by the European Psychiatric Association.

Elderly Swedish patients who took an antidepressant for at least 1 year during the 3 years prior to their dementia diagnosis had a 13% relative reduction in mortality, compared with similar new-dementia patients who had not been on an antidepressant. The researchers tracked mortality for a median of 2.1 years following dementia diagnosis in 20,050 Swedes with a new dementia diagnosis using records from 2007-2013, said Dr. Enache, a psychiatrist and neurogeriatics researcher at the Karolinska Institute in Stockholm. The analysis adjusted for differences in age, sex, mental state, number of drugs used, and living conditions.

Mitchel L. Zoler/Frontline Medical News

The protective effect from 3 years of antidepressant use was strongest in people who went on to develop Alzheimer’s disease, the most common form of dementia in the study affecting 36% of all people who developed dementia. The findings also documented the relatively frequent antidepressant use by elderly people who develop dementia. In the series of people with newly diagnosed dementia of any type, 25% were on an antidepressant at the time of their dementia diagnosis, and 4,325 (22%) had used an antidepressant at least once during the 3 years prior to their diagnosis; 1,128 (6%) of the people diagnosed with dementia had used an antidepressant during all 3 years preceding their diagnosis.

Dr. Enache admitted that it was not clear why antidepressant treatment would have this mortality effect. One possibility is that the mortality benefit came from the action of antidepressants on behavioral symptoms. Or antidepressants could have a biological effect, such as reducing production of amyloid beta or affecting neurogenesis and brain plasticity. A third possibility is that antidepressant use is a marker for overall better health care.

Whatever the explanation, the finding provides reassurance that antidepressant treatment is safe in elderly patients who are at risk of developing dementia, she noted. And patients newly diagnosed with dementia should be screened for depression, although Dr. Enache stressed that antidepressants can be prescribed for other reasons, such as anxiety or behavior problems.

All types of antidepressants had this mortality effect: tricyclics, selective serotonin reuptake inhibitors, and other types. Use of antidepressants was roughly similar across various dementia diagnoses, ranging from 22% of patients with mixed dementia and 23% of those with Alzheimer’s disease to a high of 32% among patients with Parkinson’s disease dementia.

The researchers used data collected in the national Swedish Dementia Registry, which includes about 90% of patients treated at Swedish memory clinics, along with data from the national Prescribed Drug Registry. The average age at time of dementia diagnosis was 78 years. Following Alzheimer’s disease, the other most common diagnoses were mixed dementia, in 25%, and vascular dementia, in 19%.

Dr. Enache had no disclosures.

MADRID – Elderly patients who develop dementia often are on an antidepressant when dementia is diagnosed, and unexpectedly antidepressant use during the 3 years preceding diagnosis of dementia was linked with a significantly reduced mortality risk, Dr. Daniela Enache reported at the meeting, sponsored by the European Psychiatric Association.

Elderly Swedish patients who took an antidepressant for at least 1 year during the 3 years prior to their dementia diagnosis had a 13% relative reduction in mortality, compared with similar new-dementia patients who had not been on an antidepressant. The researchers tracked mortality for a median of 2.1 years following dementia diagnosis in 20,050 Swedes with a new dementia diagnosis using records from 2007-2013, said Dr. Enache, a psychiatrist and neurogeriatics researcher at the Karolinska Institute in Stockholm. The analysis adjusted for differences in age, sex, mental state, number of drugs used, and living conditions.

Mitchel L. Zoler/Frontline Medical News

The protective effect from 3 years of antidepressant use was strongest in people who went on to develop Alzheimer’s disease, the most common form of dementia in the study affecting 36% of all people who developed dementia. The findings also documented the relatively frequent antidepressant use by elderly people who develop dementia. In the series of people with newly diagnosed dementia of any type, 25% were on an antidepressant at the time of their dementia diagnosis, and 4,325 (22%) had used an antidepressant at least once during the 3 years prior to their diagnosis; 1,128 (6%) of the people diagnosed with dementia had used an antidepressant during all 3 years preceding their diagnosis.

Dr. Enache admitted that it was not clear why antidepressant treatment would have this mortality effect. One possibility is that the mortality benefit came from the action of antidepressants on behavioral symptoms. Or antidepressants could have a biological effect, such as reducing production of amyloid beta or affecting neurogenesis and brain plasticity. A third possibility is that antidepressant use is a marker for overall better health care.

Whatever the explanation, the finding provides reassurance that antidepressant treatment is safe in elderly patients who are at risk of developing dementia, she noted. And patients newly diagnosed with dementia should be screened for depression, although Dr. Enache stressed that antidepressants can be prescribed for other reasons, such as anxiety or behavior problems.

All types of antidepressants had this mortality effect: tricyclics, selective serotonin reuptake inhibitors, and other types. Use of antidepressants was roughly similar across various dementia diagnoses, ranging from 22% of patients with mixed dementia and 23% of those with Alzheimer’s disease to a high of 32% among patients with Parkinson’s disease dementia.

The researchers used data collected in the national Swedish Dementia Registry, which includes about 90% of patients treated at Swedish memory clinics, along with data from the national Prescribed Drug Registry. The average age at time of dementia diagnosis was 78 years. Following Alzheimer’s disease, the other most common diagnoses were mixed dementia, in 25%, and vascular dementia, in 19%.

Dr. Enache had no disclosures.

[email protected]

On Twitter @mitchelzoler

MADRID – Elderly patients who develop dementia often are on an antidepressant when dementia is diagnosed, and unexpectedly antidepressant use during the 3 years preceding diagnosis of dementia was linked with a significantly reduced mortality risk, Dr. Daniela Enache reported at the meeting, sponsored by the European Psychiatric Association.

Elderly Swedish patients who took an antidepressant for at least 1 year during the 3 years prior to their dementia diagnosis had a 13% relative reduction in mortality, compared with similar new-dementia patients who had not been on an antidepressant. The researchers tracked mortality for a median of 2.1 years following dementia diagnosis in 20,050 Swedes with a new dementia diagnosis using records from 2007-2013, said Dr. Enache, a psychiatrist and neurogeriatics researcher at the Karolinska Institute in Stockholm. The analysis adjusted for differences in age, sex, mental state, number of drugs used, and living conditions.

Mitchel L. Zoler/Frontline Medical News

The protective effect from 3 years of antidepressant use was strongest in people who went on to develop Alzheimer’s disease, the most common form of dementia in the study affecting 36% of all people who developed dementia. The findings also documented the relatively frequent antidepressant use by elderly people who develop dementia. In the series of people with newly diagnosed dementia of any type, 25% were on an antidepressant at the time of their dementia diagnosis, and 4,325 (22%) had used an antidepressant at least once during the 3 years prior to their diagnosis; 1,128 (6%) of the people diagnosed with dementia had used an antidepressant during all 3 years preceding their diagnosis.

Dr. Enache admitted that it was not clear why antidepressant treatment would have this mortality effect. One possibility is that the mortality benefit came from the action of antidepressants on behavioral symptoms. Or antidepressants could have a biological effect, such as reducing production of amyloid beta or affecting neurogenesis and brain plasticity. A third possibility is that antidepressant use is a marker for overall better health care.

Whatever the explanation, the finding provides reassurance that antidepressant treatment is safe in elderly patients who are at risk of developing dementia, she noted. And patients newly diagnosed with dementia should be screened for depression, although Dr. Enache stressed that antidepressants can be prescribed for other reasons, such as anxiety or behavior problems.

All types of antidepressants had this mortality effect: tricyclics, selective serotonin reuptake inhibitors, and other types. Use of antidepressants was roughly similar across various dementia diagnoses, ranging from 22% of patients with mixed dementia and 23% of those with Alzheimer’s disease to a high of 32% among patients with Parkinson’s disease dementia.

The researchers used data collected in the national Swedish Dementia Registry, which includes about 90% of patients treated at Swedish memory clinics, along with data from the national Prescribed Drug Registry. The average age at time of dementia diagnosis was 78 years. Following Alzheimer’s disease, the other most common diagnoses were mixed dementia, in 25%, and vascular dementia, in 19%.

Dr. Enache had no disclosures.

[email protected]

On Twitter @mitchelzoler

MADRID – Elderly patients who develop dementia often are on an antidepressant when dementia is diagnosed, and unexpectedly antidepressant use during the 3 years preceding diagnosis of dementia was linked with a significantly reduced mortality risk, Dr. Daniela Enache reported at the meeting, sponsored by the European Psychiatric Association.

Elderly Swedish patients who took an antidepressant for at least 1 year during the 3 years prior to their dementia diagnosis had a 13% relative reduction in mortality, compared with similar new-dementia patients who had not been on an antidepressant. The researchers tracked mortality for a median of 2.1 years following dementia diagnosis in 20,050 Swedes with a new dementia diagnosis using records from 2007-2013, said Dr. Enache, a psychiatrist and neurogeriatics researcher at the Karolinska Institute in Stockholm. The analysis adjusted for differences in age, sex, mental state, number of drugs used, and living conditions.

Mitchel L. Zoler/Frontline Medical News

The protective effect from 3 years of antidepressant use was strongest in people who went on to develop Alzheimer’s disease, the most common form of dementia in the study affecting 36% of all people who developed dementia. The findings also documented the relatively frequent antidepressant use by elderly people who develop dementia. In the series of people with newly diagnosed dementia of any type, 25% were on an antidepressant at the time of their dementia diagnosis, and 4,325 (22%) had used an antidepressant at least once during the 3 years prior to their diagnosis; 1,128 (6%) of the people diagnosed with dementia had used an antidepressant during all 3 years preceding their diagnosis.

Dr. Enache admitted that it was not clear why antidepressant treatment would have this mortality effect. One possibility is that the mortality benefit came from the action of antidepressants on behavioral symptoms. Or antidepressants could have a biological effect, such as reducing production of amyloid beta or affecting neurogenesis and brain plasticity. A third possibility is that antidepressant use is a marker for overall better health care.

Whatever the explanation, the finding provides reassurance that antidepressant treatment is safe in elderly patients who are at risk of developing dementia, she noted. And patients newly diagnosed with dementia should be screened for depression, although Dr. Enache stressed that antidepressants can be prescribed for other reasons, such as anxiety or behavior problems.

All types of antidepressants had this mortality effect: tricyclics, selective serotonin reuptake inhibitors, and other types. Use of antidepressants was roughly similar across various dementia diagnoses, ranging from 22% of patients with mixed dementia and 23% of those with Alzheimer’s disease to a high of 32% among patients with Parkinson’s disease dementia.

The researchers used data collected in the national Swedish Dementia Registry, which includes about 90% of patients treated at Swedish memory clinics, along with data from the national Prescribed Drug Registry. The average age at time of dementia diagnosis was 78 years. Following Alzheimer’s disease, the other most common diagnoses were mixed dementia, in 25%, and vascular dementia, in 19%.

Dr. Enache had no disclosures.

[email protected]

On Twitter @mitchelzoler

MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.

A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.

Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.

He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).

Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.

To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.

Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.

MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.

A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.

Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.

He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).

Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.

To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.

Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.

MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.

A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.

Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.

He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).

Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.

To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.

Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.

MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.

A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.

Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.

He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).

Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.

To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.

Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.

[email protected]

On Twitter @mitchelzoler

MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.

A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.

Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.

He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).

Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.

To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.

Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.

[email protected]

On Twitter @mitchelzoler

MADRID – The weight gain most patients have when first starting treatment with antipsychotic medications is not inevitable.

A 12-week intervention program designed to promote exercise and a healthy diet largely blunted a big weight gain by 16 adolescents and young adults starting treatment after an initial diagnosis of psychosis in a controlled study at a single Australian center. Later follow-up further showed that a majority of participants in the program remained mostly free of excess weight 2 years after the life-style intervention, Dr. Philip B. Ward said at the meeting sponsored by the European Psychiatric Association.

Implementing this type of intervention is very important because antipsychotic-induced weight gain launches young psychiatric patients into a middle age that often includes metabolic syndrome, type 2 diabetes, and a significantly increased risk for cardiovascular disease events, said Dr. Ward, a psychiatrist at the University of New South Wales in Sydney.

He reported results from a pilot program, Keeping the Body in Mind, run at one of the university’s community clinics that gave newly-diagnosed psychiatric patients aged 15-25 years regular instruction in diet, food shopping, and cooking and in an exercise class that included individualized coaching over the course of 12 weeks. At the end of the program, average weight gain relative to baseline weight was 1.8 kg among 16 patients in the intervention group and 7.8 kg among 12 patients who received standard care at a different community clinic. (Early Interv Psychiatry. 2015. doi: 10.1111/eip.12230).

Expressed another way, 2 of the 16 participating patients (13%) had a clinically significant (at least 7%) weight gain during the 12-week program, compared with 9 of the 12 (75%) of patients with a significant weight gain in the control group.

To assess the durability of this effect, Dr. Ward and his associates did follow-up 2 years later on 12 of the participants, who showed an average 1.3-kg weight gain after 2 years, compared with their weight at the time they entered the program, Dr Ward reported. Based on this success, the university’s psychiatric clinics are now expanding the program to make it available to all patients starting treatment on antipsychotic medications, about 80 patients a year, Dr. Ward said in an interview.

Although Dr. Ward stressed the importance of lifestyle intervention, he noted that the antipsychotic drug selected for treatment can also affect the magnitude of acute weight gain. Two drugs that seem to pose some of the lowest weight-gain risks are aripiprazole and ziprasidone.

[email protected]

On Twitter @mitchelzoler

MADRID – Brexpiprazole, a new drug for treatment of schizophrenia that received Food and Drug Administration marketing approval in July 2015, showed good efficacy for patients with acute schizophrenia as well as a good safety profile in a combined analysis from three phase III trials that compared the drug against placebo.

“The incidence of withdrawals due to adverse effects was lower with brexpiprazole administered as 2-4 mg/day than with placebo, and the incidence of activating and sedating effects with brexpiprazole was low, Catherine Weiss, Ph.D., reported at the meeting, sponsored by the European Psychiatric Association.

“For long-term treatment, the lower level of sedation from treatment with brexpiprazole is an advantage,” said Dr. Weiss, director of global medical affairs for Otsuka, the company that is marketing brexpiprazole (Rexulti) along with a partner company, Lundbeck.

“We hope that brexpiprazole will be suitable for outpatients with schizophrenia who still have the potential to function in the community, to work and have relationships. Our data show that brexpiprazole prevents schizophrenia relapses and is very well tolerated,” said Dr. Emmanuelle Weiller, a senior medical adviser with Lundbeck in Copenhagen.

In its announcement of the marketing approval for brexpiprazole last year, the FDA did not include any description of how the drug works. But according to a statement from Lundbeck, the efficacy of brexpiprazole may be mediated by partial or full agonist activity at certain serotonin or dopamine receptors. The drug also has high affinity for certain noradrenaline alpha receptors.

The FDA based its approval for treatment of adults with schizophrenia (the drug was simultaneously also approved for adjunctive treatment of adults with major depressive disorder) on the results from two pivotal trials that both were published last year (Am Psychiatry. 2015 Sept 1;172[9]:870-80 and Schizophr Res. 2015 May;164[1-3]:127-35).

Dr. Weiss’ combined analysis used data collected in both of these trials as well as in a third trial, the results of which were reported in a separate talk during the same meeting session. The third brexpiprazole trial randomized 468 adults with schizophrenia to one of three treatment groups: patients who received a flexible brexpiprazole dosage, patients who received placebo, and patients randomized to treatment with quetiapine XR, a subgroup that served as an active reference arm but not a comparator arm.

The combined analysis focused on the 868 patients in any of the three trials who received either 2 mg or 4 mg of brexpiprazole daily and its comparison to 517 patients who received placebo during 6 weeks of treatment. The combined results showed an overall, average incremental reduction in the positive and negative syndrome scale (PANSS) score of 5.8 with brexpiprazole treatment compared with placebo, a statistically significant difference, Dr. Weiss reported. Treatment with brexpiprazole for 6 weeks also produced significant improvements compared with placebo for three secondary efficacy measures: clinical global impression of severity, clinical global impression of improvement, and personal and social performance.

The safety analysis showed that treatment-emergent adverse events leading to withdrawal from treatment occurred in 8% of patients on brexpiprazole and in 13% of those on placebo. None of the most common treatment-emergent adverse effects were substantially more common in the brexpiprazole-treated patients, compared with those on placebo.

Brexpiprazole’s likely role right now is as an alternative maintenance drug for patients whose schizophrenia is either not adequately controlled by an older agent, or for patients who experience intolerable adverse effects on an older drug and would like an alternative drug that does not interfere as much with their usual activities, Dr. Weiller said in an interview.

Dr. Weiss is an employee of Otsuka. Dr. Weiller is an employee of Lundbeck. Otsuka and Lundbeck funded these drug studies.

[email protected]

On Twitter @mitchelzoler

MADRID – Brexpiprazole, a new drug for treatment of schizophrenia that received Food and Drug Administration marketing approval in July 2015, showed good efficacy for patients with acute schizophrenia as well as a good safety profile in a combined analysis from three phase III trials that compared the drug against placebo.

“The incidence of withdrawals due to adverse effects was lower with brexpiprazole administered as 2-4 mg/day than with placebo, and the incidence of activating and sedating effects with brexpiprazole was low, Catherine Weiss, Ph.D., reported at the meeting, sponsored by the European Psychiatric Association.

“For long-term treatment, the lower level of sedation from treatment with brexpiprazole is an advantage,” said Dr. Weiss, director of global medical affairs for Otsuka, the company that is marketing brexpiprazole (Rexulti) along with a partner company, Lundbeck.

“We hope that brexpiprazole will be suitable for outpatients with schizophrenia who still have the potential to function in the community, to work and have relationships. Our data show that brexpiprazole prevents schizophrenia relapses and is very well tolerated,” said Dr. Emmanuelle Weiller, a senior medical adviser with Lundbeck in Copenhagen.

In its announcement of the marketing approval for brexpiprazole last year, the FDA did not include any description of how the drug works. But according to a statement from Lundbeck, the efficacy of brexpiprazole may be mediated by partial or full agonist activity at certain serotonin or dopamine receptors. The drug also has high affinity for certain noradrenaline alpha receptors.

The FDA based its approval for treatment of adults with schizophrenia (the drug was simultaneously also approved for adjunctive treatment of adults with major depressive disorder) on the results from two pivotal trials that both were published last year (Am Psychiatry. 2015 Sept 1;172[9]:870-80 and Schizophr Res. 2015 May;164[1-3]:127-35).

Dr. Weiss’ combined analysis used data collected in both of these trials as well as in a third trial, the results of which were reported in a separate talk during the same meeting session. The third brexpiprazole trial randomized 468 adults with schizophrenia to one of three treatment groups: patients who received a flexible brexpiprazole dosage, patients who received placebo, and patients randomized to treatment with quetiapine XR, a subgroup that served as an active reference arm but not a comparator arm.

The combined analysis focused on the 868 patients in any of the three trials who received either 2 mg or 4 mg of brexpiprazole daily and its comparison to 517 patients who received placebo during 6 weeks of treatment. The combined results showed an overall, average incremental reduction in the positive and negative syndrome scale (PANSS) score of 5.8 with brexpiprazole treatment compared with placebo, a statistically significant difference, Dr. Weiss reported. Treatment with brexpiprazole for 6 weeks also produced significant improvements compared with placebo for three secondary efficacy measures: clinical global impression of severity, clinical global impression of improvement, and personal and social performance.

The safety analysis showed that treatment-emergent adverse events leading to withdrawal from treatment occurred in 8% of patients on brexpiprazole and in 13% of those on placebo. None of the most common treatment-emergent adverse effects were substantially more common in the brexpiprazole-treated patients, compared with those on placebo.

Brexpiprazole’s likely role right now is as an alternative maintenance drug for patients whose schizophrenia is either not adequately controlled by an older agent, or for patients who experience intolerable adverse effects on an older drug and would like an alternative drug that does not interfere as much with their usual activities, Dr. Weiller said in an interview.

Dr. Weiss is an employee of Otsuka. Dr. Weiller is an employee of Lundbeck. Otsuka and Lundbeck funded these drug studies.

[email protected]

On Twitter @mitchelzoler

MADRID – Brexpiprazole, a new drug for treatment of schizophrenia that received Food and Drug Administration marketing approval in July 2015, showed good efficacy for patients with acute schizophrenia as well as a good safety profile in a combined analysis from three phase III trials that compared the drug against placebo.

“The incidence of withdrawals due to adverse effects was lower with brexpiprazole administered as 2-4 mg/day than with placebo, and the incidence of activating and sedating effects with brexpiprazole was low, Catherine Weiss, Ph.D., reported at the meeting, sponsored by the European Psychiatric Association.

“For long-term treatment, the lower level of sedation from treatment with brexpiprazole is an advantage,” said Dr. Weiss, director of global medical affairs for Otsuka, the company that is marketing brexpiprazole (Rexulti) along with a partner company, Lundbeck.

“We hope that brexpiprazole will be suitable for outpatients with schizophrenia who still have the potential to function in the community, to work and have relationships. Our data show that brexpiprazole prevents schizophrenia relapses and is very well tolerated,” said Dr. Emmanuelle Weiller, a senior medical adviser with Lundbeck in Copenhagen.

In its announcement of the marketing approval for brexpiprazole last year, the FDA did not include any description of how the drug works. But according to a statement from Lundbeck, the efficacy of brexpiprazole may be mediated by partial or full agonist activity at certain serotonin or dopamine receptors. The drug also has high affinity for certain noradrenaline alpha receptors.

The FDA based its approval for treatment of adults with schizophrenia (the drug was simultaneously also approved for adjunctive treatment of adults with major depressive disorder) on the results from two pivotal trials that both were published last year (Am Psychiatry. 2015 Sept 1;172[9]:870-80 and Schizophr Res. 2015 May;164[1-3]:127-35).

Dr. Weiss’ combined analysis used data collected in both of these trials as well as in a third trial, the results of which were reported in a separate talk during the same meeting session. The third brexpiprazole trial randomized 468 adults with schizophrenia to one of three treatment groups: patients who received a flexible brexpiprazole dosage, patients who received placebo, and patients randomized to treatment with quetiapine XR, a subgroup that served as an active reference arm but not a comparator arm.

The combined analysis focused on the 868 patients in any of the three trials who received either 2 mg or 4 mg of brexpiprazole daily and its comparison to 517 patients who received placebo during 6 weeks of treatment. The combined results showed an overall, average incremental reduction in the positive and negative syndrome scale (PANSS) score of 5.8 with brexpiprazole treatment compared with placebo, a statistically significant difference, Dr. Weiss reported. Treatment with brexpiprazole for 6 weeks also produced significant improvements compared with placebo for three secondary efficacy measures: clinical global impression of severity, clinical global impression of improvement, and personal and social performance.

The safety analysis showed that treatment-emergent adverse events leading to withdrawal from treatment occurred in 8% of patients on brexpiprazole and in 13% of those on placebo. None of the most common treatment-emergent adverse effects were substantially more common in the brexpiprazole-treated patients, compared with those on placebo.

Brexpiprazole’s likely role right now is as an alternative maintenance drug for patients whose schizophrenia is either not adequately controlled by an older agent, or for patients who experience intolerable adverse effects on an older drug and would like an alternative drug that does not interfere as much with their usual activities, Dr. Weiller said in an interview.

Dr. Weiss is an employee of Otsuka. Dr. Weiller is an employee of Lundbeck. Otsuka and Lundbeck funded these drug studies.

[email protected]

On Twitter @mitchelzoler