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      Neuropsychiatric Disease and Treatment (submit here)

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      Cariprazine: Patients with Treatment-Resistant Schizophrenia

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          Abstract

          Schizophrenia is a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan, and it is a disabling psychiatric brain syndrome whose phenotype is characterized by three core symptom domains: positive symptoms, such as delusions and hallucinations, negative symptoms, which include lack of motivation and social withdrawal, and cognitive impairment. Moreover, patients with schizophrenia have severe problems with personal and social relations which affect their quality of life. Antipsychotic medications in conjunction with psychosocial interventions can help patients achieve recovery. Here are described three clinical cases of schizophrenic patients treated with cariprazine for inadequate response to a previous treatment. The purpose of this clinical series is to give useful information for the use of cariprazine in clinical practice.

          Most cited references22

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          Schizophrenia

          Schizophrenia is a chronic psychiatric disorder with a heterogeneous genetic and neurobiological background that influences early brain development, and is expressed as a combination of psychotic symptoms - such as hallucinations, delusions and disorganization - and motivational and cognitive dysfunctions. The mean lifetime prevalence of the disorder is just below 1%, but large regional differences in prevalence rates are evident owing to disparities in urbanicity and patterns of immigration. Although gross brain pathology is not a characteristic of schizophrenia, the disorder involves subtle pathological changes in specific neural cell populations and in cell-cell communication. Schizophrenia, as a cognitive and behavioural disorder, is ultimately about how the brain processes information. Indeed, neuroimaging studies have shown that information processing is functionally abnormal in patients with first-episode and chronic schizophrenia. Although pharmacological treatments for schizophrenia can relieve psychotic symptoms, such drugs generally do not lead to substantial improvements in social, cognitive and occupational functioning. Psychosocial interventions such as cognitive-behavioural therapy, cognitive remediation and supported education and employment have added treatment value, but are inconsistently applied. Given that schizophrenia starts many years before a diagnosis is typically made, the identification of individuals at risk and those in the early phases of the disorder, and the exploration of preventive approaches are crucial.
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            Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment

            Abstract Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D2 antagonists or partial D2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.
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              Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial

              Although predominant negative symptoms of schizophrenia can be severe enough to cause persistent impairment, effective treatment options are lacking. We aimed to assess the new generation antipsychotic cariprazine in adult patients with predominant negative symptoms.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                ndt
                neurodist
                Neuropsychiatric Disease and Treatment
                Dove
                1176-6328
                1178-2021
                14 July 2021
                2021
                : 17
                : 2327-2332
                Affiliations
                [1 ]Kliniken Essen-Mitte, Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin , Essen, Germany
                Author notes
                Correspondence: Thomas Aubel Kliniken Essen-Mitte, Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin , Henricistraße 92, Essen, 45136, GermanyTel +4920117430005 Email T.Aubel@kem-med.com
                Article
                315653
                10.2147/NDT.S315653
                8286718
                34285492
                c9f705f5-04fd-4959-8595-24fbb9e3b974
                © 2021 Aubel.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 14 April 2021
                : 08 July 2021
                Page count
                Figures: 0, Tables: 1, References: 24, Pages: 6
                Categories
                Case Series

                Neurology
                cariprazine,schizophrenia,paranoid schizophrenia,negative symptoms,resistant schizophrenia,antipsychotics

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