clopenthixol-decanoate and Psychotic-Disorders

Eighty-three acutely disturbed, psychotic patients were included in an open multicentre study. The aim of the study was to evaluate the clinical effect of zuclopenthixol acetate in Viscoleo (CPT-A). Each patient received from one to four intramuscular injections of CPT-A during the 6-day study period. The duration of action after one injection was between 2 and 3 days and doses from 50 mg to 150 mg were sufficient for most patients. Treatment with CPT-A caused a pronounced and rapid reduction of the psychotic symptoms. At the end of the 6-day test period the mean total score on BPRS in acute non-manic and exacerbated chronic patients was reduced by more than 50 per cent. In acute manic patients the mean total score on BRMS was reduced by 57 per cent already 1 day after injection. Rapidly after the injection of CPT-A a useful short-acting sedation can be expected, but the risk for oversedation even after a second injection is low. The frequency of unwanted effects, including extrapyramidal reactions, was low and the severity of symptoms was most often mild. With a rapid onset of action, a duration of effect of 2 to 3 days, and few and mild side effects, CPT-A offers advantages over the neuroleptic preparations conventionally used in the initial treatment of acutely disturbed, psychotic patients.

Topics: Acute Disease; Adolescent; Adult; Antipsychotic Agents; Bipolar Disorder; Clinical Trials as Topic; Clopenthixol; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Psychiatric Status Rating Scales; Psychotic Disorders; Thioxanthenes

The high prevalence of comorbid illicit drug use in persons with chronic psychotic illness represents a strong determinant of psychotic relapse and rehospitalization. Epidemiological studies indicate changing patterns of illicit drug use in Australia, which are concerning because of increased use of crystal methamphetamine, also known as "ice." An important complication of habitual use of crystal methamphetamine is the development of a dose-dependent acute psychotic reaction. We report a case of an acute psychotic relapse in response to polydrug use most notable for multiple recent binges of crystal methamphetamine. Unlike previously described case reports, our patient's acute psychosis was refractory to ultra-high doses of multiple antipsychotic medications. This presented safety challenges due to the risk of serious side effects with high-dose antipsychotic medications.. A 30-year-old white man with a past history of schizoaffective disorder was brought to our emergency department by the police in a state of extreme agitation, combativeness, and paranoia after use of cannabis and crystal methamphetamine. Despite existing compliance with zuclopenthixol decanoate depot medication, he required multiple emergency injections of zuclopenthixol acetate, and regular high-dose droperidol, chlorpromazine, and lorazepam. However, he remained severely agitated and psychotic with continuous threats of harm to others. A test of antipsychotic drug metabolism by cytochrome P450 enzymes did not reveal a pharmacogenetic cause for the poor therapeutic efficacy of antipsychotic medications. His psychosis did not appear to be modified by psychoactive medications but was instead self-limited to the presence of endogenous methamphetamine within his system. He fully recovered 96 to 120 hours post-presentation and was discharged home with out-patient clinic follow-up.. The current case highlights the challenging nature of a severe psychotic relapse precipitated by illicit substances that is resistant to medical management. High doses of multiple antipsychotic medications may be required to manage dangerous behaviors associated with these acute psychotic relapses. These patients require close monitoring for adverse effects with adjustment of dosing to ensure the optimal balance of risk versus benefit while the patient is acutely psychotic. The results are of relevance for the management of psychiatric emergencies in emergency departments and acute mental health settings.

Topics: Adult; Amphetamine-Related Disorders; Antipsychotic Agents; Chlorpromazine; Clopenthixol; Droperidol; Drug Administration Schedule; Emergency Medical Services; Humans; Hypnotics and Sedatives; Lorazepam; Male; Marijuana Abuse; Methamphetamine; Psychotic Disorders; Time Factors; Treatment Outcome; Violence

1. The zuclopenthixol concentrations in serum has been investigated in man and dog after injection of three different zuclopenthixol preparations. These were zuclopenthixol dihydrochloride in aqueous solution, zuclopenthixol acetate in oil and zuclopenthixol decanoate in oil. 2. The pharmacokinetic profiles of the three injectable zuclopenthixol preparations are very different. Maximum serum levels are obtained after about 1 hour for zuclopenthixol dihydrochloride, after 36 hours for zuclopenthixol acetate and after one week for zuclopenthixol decanoate. 3. The different pharmacokinetics of the three injectable zuclopenthixol preparations are reflected in their clinical properties.

Topics: Adult; Aged; Animals; Antipsychotic Agents; Clopenthixol; Dogs; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Psychotic Disorders; Reference Values; Schizophrenia; Thioxanthenes

After reviewing the different pharmacological treatments of psychotic states, the author presents an evaluation of the clinical effectiveness of Clopixol Acutard (zuclopenthixol acetate in a viscoleo solution): 48% of the 23 patients (14 acute psychoses and 9 acute phases in chronic psychotic patients) respond well to the treatment, and only 17% suffered from important side effects, which demonstrates the good tolerance of the medication. Clopixol Acutard convinces by its rapid effect and with a mean of 5 injections leads to sedation, which is particularly helpful in patients with paranoid symptoms. The treatment interval, i.e. an injection every 2 or 3 days, is appreciated by the patients as well as by the therapists, for it establishes a less intrusive relationship.

Topics: Adult; Aged; Clopenthixol; Crisis Intervention; Drug Administration Schedule; Female; Hospitals, Psychiatric; Humans; Male; Middle Aged; Psychotic Disorders; Thioxanthenes

An open, multi-centre study was carried out in 69 patients with an acute psychotic episode to assess the efficacy and side-effects of treatment with oral zuclopenthixol dihydrochloride. Patients were treated until the acute episode was considered terminated by the clinician and, although dosage could be adjusted to allow optimum clinical response, the majority received 25 mg zuclopenthixol dihydrochloride 3-times daily throughout the trial period. Assessments were made before and during treatment using the BPRS and CGI rating scales and a check-list of side-effects. The results showed that 55 (80%) patients had a successful response to treatment. Almost half (33) of the patients responded fully to the drug within 3 weeks and by the end of 5-weeks' treatment this had increased to over 70% (49). A further 6 patients responded after 6 to 9 weeks of treatment. The drug was generally well tolerated and the majority of patients had either no side-effects or side-effects which did not overtly affect performance.

Topics: Adolescent; Adult; Antipsychotic Agents; Clopenthixol; Delayed-Action Preparations; Humans; Male; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia; Sex Factors; Thioxanthenes; Time Factors