Use of Metabolically Friendly Antipsychotics; Depression & Cognition in Schizophrenia
Short author bio
Christoph Correll, MD, is professor of Psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York, and Medical Director of the Recognition and Prevention (RAP) program at the Zucker Hillside Hospital in New York. He completed his medical studies in Berlin and Scotland and his research and clinical work focuses on the identification, characterisation and treatment of adults and youths with severe psychiatric disorders, with a further focus on psychopharmacology and the risk–benefit evaluation of psychotropic medications. Professor Correll has authored or co-authored over 450 journal articles, has received over 30 national and international research awards and fellowships for his work and is listed by Thomson Reuters as one of “the most influential scientific minds” and “top 1% cited scientists in the area of psychiatry.”
[When prescribing drugs], starting with long-term thinking from the beginning is key.
In these placebo-controlled trials I don’t know who will be on placebo and we don’t want them to hurt themselves or others, so benzos [benzodiazepine] are normally given. We need to do the same.”
So, we have to be really careful to not let them slide into depression and not underdiagnose it and think “oh, it’s just negative symptoms.”
In this video clip, Prof Correll talks about the benefits of targeted sedation compared with exploiting a drug’s side effect for effective metabolically healthy and safe medications. Moving on from acute efficacies, he also emphasises the importance of maintenance and looks at how antipsychotics perform compared with placebo.
He continues with a focus on how depression affects a patient’s overall quality of life and the dangers of underdiagnosing depression as simply negative symptoms associated with an illness.
He presents indirect evidence from a study of patients with schizophrenia who also had depression to highlight the association between patient recovery and dose dependent medication.
Moving to a discussion of cognition, Prof Correll concludes this video excerpt with data from studies of lurasidone vs ziprasidone where lab test scores were used to determine patient improvement.
Comparing a study of lurasidone vs quetiapine, he describes symptom improvement at 6 weeks and relapse prevention, and provides data showing how the benefit to patients is increased with duration on lurasidone.
Take Home Bullet Points
- Relapse is prevented for every 3rd to 5th patient who continues on an antipsychotic versus stopping
- Rehabilitation can only be successful when patients are back on track, especially early in their illness prior to any downward spiral
- Both dose effect and duration effect need to be taken into account
- Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, Davis JM. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet. 2012 Jun 2;379(9831):2063-71.
- Harvey PD, Ogasa M, Cucchiaro J, Loebel A, Keefe RS. Performance and interview-based assessments of cognitive change in a randomized, double-blind comparison of lurasidone vs. ziprasidone. Schizophr Res. 2011 Apr;127(1-3):188-94.
- Harvey PD, Siu CO, Hsu J, Cucchiaro J, Maruff P, Loebel A. Effect of lurasidone on neurocognitive performance in patients with schizophrenia: a short-term placebo- and active-controlled study followed by a 6-month double-blind extension. Eur Neuropsychopharmacol. 2013 Nov;23(11):1373-82.