Кетогенная диета при шизофрении

Summary: These results support that ketogenic diet may present a novel therapeutic approach through restoring brain energy metabolism in schizophrenia. Randomized controlled clinical trials are needed to further show the efficacy of ketogenic diet as a co-treatment to manage both clinical symptoms and metabolic abnormalities inherent to the disease and resulted by antipsychotic treatment.

Ketogenic Diet for Schizophrenia: Clinical Implication

Making sense of CYP2D6 and CYP1A2 genotype vs phenotype

• Unlike most other CYP450 enzymes, CYP2D6 is not very susceptible to enzyme induction. Therefore, genetics, rather than drug therapy, accounts for most ultra-rapid CYP2D6 metabolizers.

• When using multiple medications that are substrates and/or inhibitors of CYP2D6, genotyping may not reflect the true prevalence of the CYP2D6 poor metabolizer phenotype. 

• The activity of CYP1A2 alleles is largely determined by environmental factors and genetic variability.

Making sense of CYP2D6 and CYP1A2genotype vs phenotype 

Комбинация арипипразола с клозапином эффективнее монотерапии антипсихотиком

Certain antipsychotic polytherapies, including aripiprazole and clozapine, are associated with a lower risk of psychiatric rehospitalization in patients with schizophrenia, according to Jari Tiihonen, MD, PhD, of the Karolinska Institute in Stockholm, and his associates.

The study population included a total of 62,250 patients from the Finnish Hospital Discharge register who were treated for schizophrenia in the inpatient setting from 1972 to 2014. The median patient age was 45.6 years and the median length of follow-up was 14.1 years. Over the study period, 58.8% of this cohort were readmitted for psychiatric inpatient care, 67.2% used antipsychotic polypharmacy during the follow-up, and 57.5% were exposed to antipsychotic polypharmacy for at least 90 days, Dr. Tiihonen and his associates wrote in JAMA Psychiatry.

The combination of aripiprazole and clozapine was associated with the lowest risk of psychiatric rehospitalization, compared with those who received no therapy (hazard ratio, 0.42, 95% confidence interval, 0.39-0.46). Clozapine alone was the most effective antipsychotic monotherapy (HR, 0.49; 95% CI, 0.47-0.51), and when aripiprazole/clozapine was compared with clozapine alone, the polytherapy was significantly more effective (HR, 0.86; 95% CI, 0.79-0.94).

The difference between aripiprazole/clozapine and clozapine alone was even greater in patients who initially were hospitalized for their first episode of schizophrenia (HR, 0.78; 95% CI, 0.63-0.96). Overall, any antipsychotic polypharmacy was associated with a 7%-13% lower risk of hospitalization, compared with any monotherapy; clozapine alone was the only monotherapy among the 10 most effective treatments, the authors noted.

 Aripiprazole/clozapine combo more effective than monotherapies