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Biomedical subjects

Andrew Francis

Publications and source records attributed to Andrew Francis.

15 recordsLinked to original sources
PubMed2005

Best clinical practice with ziprasidone IM: update after 2 years of experience.

Acute agitation is a common psychiatric emergency often treated with intramuscular (i.m.) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional i.m. antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon) is the first second-generation, or atypical, antipsychotic to become available in an i.m. formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings. In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol i.m. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from i.m. to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical setting are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics.

Administration, Oral↗
PubMed2005

Naturalistic study of intramuscular ziprasidone versus conventional agents in agitated elderly patients: retrospective findings from a psychiatric emergency service.

BACKGROUND: The newer atypical antipsychotics have gained prominence as first-line oral agents to treat severe agitation, but their use in the psychiatric emergency service (PES) setting has been limited because of the unavailability of parenteral formulations. The advent of parenteral formulations of atypical antipsychotics, beginning with ziprasidone in 2002, might afford an alternative treatment option. OBJECTIVE: The objective of this article was to determine the effectiveness and tolerability of i.m. ziprasidone used to treat agitation in elderly patients. METHODS: In this data analysis, the PES database at the Department of Psychiatry and Behavioral Science, School of Medicine, State University of New York, Stony Brook, New York, was searched for records of patients aged > or = 65 years who received a single 20-mg dose of i.m. ziprasidone for the treatment of acute agitation. Efficacy data from these patients were compared with those from an age- and gender-matched sample that received conventional treatment (CT group) with i.m. haloperidol, with or without lorazepam. Data were also included from a previous naturalistic outcomes study to determine the effectiveness and tolerability of i.m. ziprasidone in patients treated at the PES at Stony Brook. Additional records were identified using a search of pharmacy and restraint records for PES-treated geriatric patients who received i.m. ziprasidone over a 2.5-year period beginning in late 2002, when i.m. ziprasidone became available. In some patients in the ziprasidone group, the effects of the drug on agitation were assessed prospectively by blinded psychiatrists using the Behavioural Activity Rating Scale (BARS) (1--difficult or unable to arouse to 7--violent, requires restraint). Also included in the analysis were data concerning use of rescue medication (oral or parenteral) other than the study drug within 2 hours of initial treatment, restraint time, and adverse events (changes in vital sign measurements and electrocardiography [ECG]). RESULTS: The database revealed 15 patients who received ziprasidone (9 men, 6 women; age range, 65-87 years) and 20 patients who were included in the CT sample (13 men, 7 women; age range, 65-88 years). In the 6 cases rated on the BARS, the mean (SE) baseline score was high (6.8 [0.1]), with a decrease to 4.0 (0.4) (P < 0.05) at 45 minutes after study drug administration and to 2.8 (0.4) (P < 0.01) at 120 minutes. Rescue medication was needed in 4 ziprasidone cases and 2 CT cases (P = NS), and mean (SE) restraint times did not vary significantly between groups (ziprasidone [n = 12], 85 [15] minutes; CT [n = 17], 83 [12] minutes). No clinically significant effects on blood pressure or heart rate were noted, and no cardiac or other adverse events were reported. ECG results with ziprasidone (n = 3) or CT (n = 6) were unremarkable. CONCLUSIONS: The results of this data analysis of the effects of i.m. ziprasidone suggest that this agent was similarly effective compared with CT and was well tolerated in this geriatric population with acute agitation presenting to a PES. Ziprasidone might be an effective, well-tolerated treatment option for acute agitation in elderly patients presenting to a PES.

Aged↗
PubMed2004

Intramuscular antipsychotics: clinical experience review.

Acute agitation is a therapeutic dilemma. Rapid control of agitation is necessary to minimize danger both to recipients of care and to caregivers. Although a comprehensive assessment may ultimately be necessary to determine the cause of agitation and to identify or exclude underlying medical illness, it is often imperative to treat agitation immediately. In this imperfect clinical world, it is essential to have treatments that are both safe and effective for patients with a wide variety of causes of agitation.

Antipsychotic Agents↗
PubMed1993

Caffeine Pretreatment Enhances Clinical Efficacy and Reduces Cognitive Effects of Electroconvulsive Therapy.

In an open clinical trial, depressed patients received age-dosed, brief-pulse electroconvulsive therapy (ECT) either with or without 500 mg i.v. caffeine sodium benzoate before each treatment. Caffeine-pretreated patients required fewer ECT treatments, and after three to four treatments, their Hamilton Depression Scale (HDS) scores were significantly lower. At the end of the ECT course, both groups reached the same reduction in HDS scores. Of five memory tests, one showed better performance at the end of the ECT course for the caffeine-pretreated compared with the non-caffeine-pretreated patients. The results argue that caffeine-modified ECT differs from unmodified ECT in speed of response and the effects on cognitive tests.

Journal Article↗
PubMed1993

Aortic Aneurysm and Electroconvulsive Therapy.

We report two patients with confirmed aortic aneurysm who successfully received ECT. A review of the literature on ECT finds 13 prior case descriptions. Based on the reported cases and literature review, we conclude that ECT in patients with aortic aneurysm is a safe and effective procedure. Although patients may benefit from additional medication for blood pressure control, the evidence suggests that they may be safely treated without invasive monitoring.

Journal Article↗
PubMed1993

Sustained Downregulation of Cortical Adrenergic Receptor Density with Maintenance Electroconvulsive Stimulation.

Central beta-adrenergic receptor downregulation is a robust and reversible neurochemical finding in animals after a course of electroconvulsive stimulation (ECS) or antidepressant drug administration. In addition, beta-receptors are essential components of monoamine-based models of affective disorder pathogenesis and treatment. We tested whether the downregulation in rat cortical beta-receptor density observed after an initial series of ECS is maintained over 2 months of maintenance ECS. Our findings confirm prior reports, in the absence of maintenance ECS, that receptor density is decreased after a course of 10 daily ECS, with recovery to baseline 16 days after the last ECS. In contrast, when maintenance ECS was given for 2 months after an initial series of 10 ECS, a schedule of maintenance ECS at two per week was sufficient to sustain the receptor downregulation. The results are discussed in terms of the neurochemical study of ECS in animals and implications for maintenance ECS.

Journal Article↗
PubMedDate not supplied

Rapid-acting IM ziprasidone in a psychiatric emergency service: a naturalistic study.

Atypical antipsychotics have gained acceptance as first-line treatment for psychotic disorders. Rapid-acting intramuscular (IM) atypicals may supplant benzodiazepine and/or neuroleptic alternatives. IM atypical ziprasidone studies excluded severe psychiatric agitation (PSYCH), or that due to the abuse of alcohol (ETOH) or other substances (SUBS). We report Behavioral Activity Rating Scale agitation scores (range, 1-7) and duration of physical restraints in a naturalistic study in a psychiatric emergency service using IM ziprasidone 20 mg and various doses for conventional antipsychotics. Baseline scores were high for PSYCH, ETOH and SUBS patients (mean, 6.5, 6.9 and 6.6, respectively). Agitation decreased rapidly from baseline with ziprasidone [mean, 5.6, 5.3 and 5.8, respectively, at 15 min (P<.05 for all), and 4.2, 4.1 and 4.1, respectively, at 30 min (P<.01 for all)]. At 2 h, scores were 2.6, 2.1 and 2.3 (P<.01 for all versus baseline). For 9 patients receiving conventional IM antipsychotics, scores were 6.6 (baseline), 5.7 (15 min), 4.2 (30 min) and 2.9 (2 h) (P<.02 versus ziprasidone). Compared with restraint durations from 80 patients receiving conventional IM agents 1 month prior to this study, restraint duration decreased from 91+/-4 to 54+/-3 min with ziprasidone (n=77; P<.01) and varied with conventional IM agents (mean, 60+/-12 min; n=4; P=NS). None of the 19 ziprasidone patients who received electrocardiograms showed prolonged QTc; one had a dystonic reaction. IM ziprasidone appears effective for severe agitation, including agitation associated with alcohol or substance intoxication, and may reduce time in restraints.

Adolescent↗