Douglas Noordsy
Clinical Professor, Psychiatry and Behavioral Sciences
Web page: http://web.stanford.edu/people/dnoordsy
Bio
Douglas L. Noordsy, MD, is Clinical Professor, Director of Lifestyle Psychiatry and co-founder of the Sports Psychology & Psychiatry clinic in the Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine. Dr. Noordsy was previously Professor of Psychiatry at the Geisel School of Medicine at Dartmouth. His research interests include effects of physical exercise on neurotrophic factors, brain volume and function and mental health and wellbeing. He is particularly interested in the role of physical exercise for prevention of progression of early psychosis and interactions between social and physical aspects of team sports. Dr. Noordsy is a member of the American College of Psychiatry, American College of Lifestyle Medicine and is a Distinguished Fellow of the American Psychiatric Association. He is a member of the editorial boards for Community Mental Health Journal and Mental Health & Physical Activity. Dr. Noordsy was recognized with the Exemplary Psychiatrist Award from the National Alliance on Mental Illness in 2001, and the Excellence in Leadership Award from the Department of Psychiatry & Behavioral Sciences at Stanford in 2018. He launched the Stanford Lifestyle & Sports Psychiatry Special Initiative of the Department of Psychiatry in 2024 and is seeking philanthropic partners.
https://med.stanford.edu/psychiatry/special-initiatives/lifestyle.html
https://med.stanford.edu/psychiatry/patient_care/lifestyle.html
Clinical Focus
- Psychiatry
- Early psychosis
- Sports Psychiatry
- Lifestyle medicine
Academic Appointments
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Clinical Professor, Psychiatry and Behavioral Sciences
Administrative Appointments
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Director, Lifestyle & Sports Psychiatry special initiative, Department of Psychiatry & Behavioral Sciences (2023 - Present)
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Associate Chair of Clinical Integration and Coordination, Psychiatry & Behavioral Sciences (2016 - 2018)
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Director of Sports Psychiatry, Psychiatry & Behavioral Sciences (2015 - 2019)
Professional Education
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Medical Education: Washington University School Of Medicine Registrar (1985) MO
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Board Certification: American Board of Psychiatry and Neurology, Psychiatry (1990)
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Residency: Darmouth-Hitchcock Medical Center (1989) NH
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M.D., Washington University School of Medicine, Medicine (1985)
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B.S. magna cum laude, St. Lawrence University, Chemistry (1981)
2024-25 Courses
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Independent Studies (5)
- Directed Reading in Psychiatry
PSYC 299 (Aut, Win, Spr, Sum) - Graduate Research
PSYC 399 (Aut, Win, Spr, Sum) - Medical Scholars Research
PSYC 370 (Aut, Win, Spr, Sum) - Teaching in Psychiatry
PSYC 290 (Aut, Win, Spr, Sum) - Undergraduate Research, Independent Study, or Directed Reading
PSYC 199 (Aut, Win, Spr, Sum)
- Directed Reading in Psychiatry
All Publications
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The Role of Physical Exercise in Cognitive Preservation: A Systematic Review.
American journal of lifestyle medicine
2024; 18 (4): 574-591
Abstract
Dementia, or major neurocognitive disorder, is one of the most common causes of disability and dependency in older adults with far-reaching social, physical, and economic impacts. In the absence of adequate treatment, much research has been directed towards prevention. Physical exercise has been shown to increase cerebral blood flow, amplify production of neurotrophic factors, and enhance brain volume. Whether these changes on a structural and cellular level result in cognitive preservation is less clear. This systematic review synthesizes findings from seventeen randomized controlled trials that examine the effects of physical activity on global cognition, memory, and executive function in older adults. Cognitive benefits of exercise are strongest for those who are cognitively intact or with mild cognitive impairment. In studies with long-term follow up, cognitive gains tended to decay after cessation of physical intervention suggesting that sustained physical exercise may be required to preserve cognitive function in older adults prior to onset of dementia.
View details for DOI 10.1177/15598276231201555
View details for PubMedID 39262880
View details for PubMedCentralID PMC11384842
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The Association Between Well-Being and Empathy in Medical Residents: A Cross-Sectional Survey.
Journal of integrative and complementary medicine
2024
Abstract
Objective: To evaluate the extent to which personal well-being may be associated with empathy, while controlling for potential confounders. Settings/Location: Residency programs throughout the United States. Subjects: A total of 407 medical residents from residencies including general medicine, surgery, specialized and diagnostic medicine participated in this study. Outcome Measures: Well-being was measured using the modified existential well-being subscale of the spiritual well-being scale. Empathy was measured using the Jefferson Scale of Empathy. Results: Well-being was found to be positively correlated with empathy when adjusted for possible confounders (p < 0.001). In addition to well-being, other factors noted to be statistically significant contributors to higher empathy scores while controlling for the others included age, gender, year in residency, specialty, and work-hours (p < 0.05 for each). After controlling for these factors, a resident's year in residency was not found to be a statistically significant contributor to empathy score. Conclusions: In this study, well-being was associated with empathy in medical and surgical residents. Empathy is a fundamental component of physician competency, and its development is an essential aspect of medical training. These findings suggest that efforts to increase well-being may promote empathy among medical residents.
View details for DOI 10.1089/jicm.2023.0116
View details for PubMedID 38416862
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The Role of Physical Exercise in Cognitive Preservation: A Systematic Review
AMERICAN JOURNAL OF LIFESTYLE MEDICINE
2023
View details for DOI 10.1177/15598276231201555
View details for Web of Science ID 001066589000001
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The Future of Yoga for Mental Health Care.
International journal of yoga
2023; 16 (1): 38-41
Abstract
Yoga is an integrated holistic system originating in India that provides a path to alleviate physical, mental, and emotional suffering. Interest in the application of yoga in health care to manage and treat psychiatric conditions has grown. While research and clinical interventions using yoga show promising results for improving mental and emotional well-being, more data are needed. This perspective article summarizes the current evidence on yoga as a treatment for mental health conditions, potential mechanisms of action, future directions, and a call to action for proactive clinical and research agendas for yoga-based interventions in mental health care.
View details for DOI 10.4103/ijoy.ijoy_25_23
View details for PubMedID 37583539
View details for PubMedCentralID PMC10424272
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Inspire self report scale (ISRS): A feasibility study of a Novel self report scale for people with schizophrenia spectrum disorders.
Journal of psychiatric research
2023; 165: 248-253
Abstract
Clinician-rated symptom scales are the current standard for outcome measures in Schizophrenia Spectrum Disorders (SSD) research. There has been growing interest in the development of self-report measures for people with SSD to support measurement-based care and inclusive research. We developed the Inspire Self Report Scale (ISRS), which measures the current magnitude of well-being, mood symptoms, psychosis, negative symptoms and cognition using 10 questions on a Likert or Visual analogue scale (VAS). The main aim of this report was to investigate the correlation and concordance between patient self-report and clinician ratings on the ISRS during a clinical encounter. When ratings were discordant, we sought to identify whether the participant's or psychiatrist's rating was more accurate. The results indicated a moderately strong statistically significant correlation between participant and clinician ratings. There was a moderate concordance between participant and clinician ratings on the ISRS. When the results were discordant, the participant ratings were assessed to be more accurate than the clinician rating over 70% of the time. The ISRS has distinct utility compared to existing scales due to the measurement of present symptom severity, capturing multiple clinical domains, and time efficiency and ease of use. Thus, it may be useful in clinical and research settings.
View details for DOI 10.1016/j.jpsychires.2023.05.047
View details for PubMedID 37531843
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Impacts of COVID-19 on Mental Health and Training in US Professional Endurance Athletes.
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
2021
Abstract
OBJECTIVE: We examined how professional athletes are affected by COVID-19. Our primary aim was to assess changes in mental health that occurred after COVID-19 restrictions, and our secondary aim was to assess changes in exercise volume and intensity.DESIGN: Cross-sectional study.SETTING: United States.PARTICIPANTS: Strava professional endurance athletes.ASSESSMENT OF RISK FACTORS: Participants completed a survey, and a subset of participants consented to have their activity data analyzed. The survey included questions on COVID-19 symptoms, exercise, and mental health, as measured by a modified Patient Health Questionnaire.MAIN OUTCOME MEASURES: Participants were asked about 2 periods in 2020: before COVID-19 (January 1-March 14) and during COVID-19 (March 15-August 25), and activity data from both periods were downloaded. Activity data consisted of Global Positioning System and self-reported uploads.RESULTS: One hundred thirty-one male and female Strava athletes were enrolled, and a subset of athletes (n = 114) consented to have their activity data analyzed. During COVID-19 restrictions, 22.2% of participants reported feeling down or depressed and 27.4% of participants reported feeling nervous or anxious at least half the days in a week compared with 3.8% and 4.6% before COVID-19 restrictions, respectively (P < 0.0001). Activity data revealed a significant increase (P < 0.0001) in exercise minutes per day during COVID-19 (mean = 103.00, SD = 42.1) compared with before COVID-19 restrictions (mean = 92.4, SD = 41.3), with no significant changes in intensity.CONCLUSIONS: Athletes reported significant increases in feeling down or depressed and nervous or anxious despite an increase in exercise duration during COVID-19. Future research should assess how to support athletes with mental health resources.
View details for DOI 10.1097/JSM.0000000000000983
View details for PubMedID 34711711
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The Lifestyle Psychiatry project of the WPA Section on Medicine, Psychiatry and Primary Care.
World psychiatry : official journal of the World Psychiatric Association (WPA)
2021; 20 (3): 454-455
View details for DOI 10.1002/wps.20898
View details for PubMedID 34505390
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Increased activation product of complement 4 protein in plasma of individuals with schizophrenia.
Translational psychiatry
2021; 11 (1): 486
Abstract
Structural variation in the complement 4 gene (C4) confers genetic risk for schizophrenia. The variation includes numbers of the increased C4A copy number, which predicts increased C4A mRNA expression. C4-anaphylatoxin (C4-ana) is a C4 protein fragment released upon C4 protein activation that has the potential to change the blood-brain barrier (BBB). We hypothesized that elevated plasma levels of C4-ana occur in individuals with schizophrenia (iSCZ). Blood was collected from 15 iSCZ with illness duration < 5 years and from 14 healthy controls (HC). Plasma C4-ana was measured by radioimmunoassay. Other complement activation products C3-ana, C5-ana, and terminal complement complex (TCC) were also measured. Digital-droplet PCR was used to determine C4 gene structural variation state. Recombinant C4-ana was added to primary brain endothelial cells (BEC) and permeability was measured in vitro. C4-ana concentration was elevated in plasma from iSCZ compared to HC (mean=654±16ng/mL, 557±94 respectively, p=0.01). The patients also carried more copies of the C4AL gene and demonstrated a positive correlation between plasma C4-ana concentrations and C4A gene copy number. Furthermore, C4-ana increased the permeability of a monolayer of BEC in vitro. Our findings are consistent with a specific role for C4A protein in schizophrenia and raise the possibility that its activation product, C4-ana, increases BBB permeability. Exploratory analyses suggest the novel hypothesis that the relationship between C4-ana levels and C4A gene copy number could also be altered in iSCZ, suggesting an interaction with unknown genetic and/or environmental risk factors.
View details for DOI 10.1038/s41398-021-01583-5
View details for PubMedID 34552056
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Advancing Medical Education Through Innovations in Teaching During the COVID-19 Pandemic.
The primary care companion for CNS disorders
2021; 23 (1)
Abstract
BACKGROUND: Medicine relies on education of trainees for growth of the field. Medical education has benefitted from a rapid pace of innovation, but due to the coronavirus disease 2019 (COVID-19) pandemic, many paradigms underpinning the medical education of trainees shifted-rendering numerous teaching modalities unusable. The COVID-19 pandemic, however, accelerated the development of novel teaching methodologies, which our trainees are now adapting to. We sought to examine emerging teaching methodologies to understand the opportunities available for medical education to innovate our teaching practices for learners in the midst of the COVID-19 pandemic.METHODS: In this narrative review, we drew upon the experiences of the authors as both life-long learners and educators. We then reviewed literature pertaining to novel teaching methodologies developed in medical education since the start of the COVID-19 pandemic.RESULTS: Several medical specialties have employed novel teaching methodologies including use of telemedicine, remote teaching, online curricula, virtual rotations, virtual conferences, simulations, and learning consortia to continue engaging trainees during the COVID-19 pandemic. There is a paucity of literature that addresses efficacy of novel teaching methodologies compared to more traditional teaching methodologies.CONCLUSIONS: The COVID-19 pandemic presents an opportunity for medical education to combine new and innovative teaching methodologies to create novel, accessible, and engaging learning opportunities for our trainees.
View details for DOI 10.4088/PCC.20nr02847
View details for PubMedID 34000143
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Lived experience perspectives on reducing the duration of untreated psychosis: the impact of stigma on accessing treatment
PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES
2020
View details for DOI 10.1080/17522439.2020.1754890
View details for Web of Science ID 000531980000001
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VALIDATION OF THE NDSE, A NEW SELF REPORT SCALE FOR PEOPLE WITH PSYCHOSIS
OXFORD UNIV PRESS. 2019: S348
View details for Web of Science ID 000466725400609
- Lifestyle Psychiatry edited by Noordsy, D. L. American Psychiatric Association Publishing. 2019
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Lifestyle Psychiatry Preface
LIFESTYLE PSYCHIATRY
2019: XXI-XXII
View details for Web of Science ID 000552225000002
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Lifestyle Psychiatry Conclusion
LIFESTYLE PSYCHIATRY
2019: 367–68
View details for Web of Science ID 000552225000023
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Helping People Find Synergy The Transformative Potential of Lifestyle Psychiatry
LIFESTYLE PSYCHIATRY
2019: 343–52
View details for Web of Science ID 000552225000021
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Introduction to Lifestyle Psychiatry
LIFESTYLE PSYCHIATRY
2019: 3–11
View details for Web of Science ID 000552225000003
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Psychopharmacology for People in Early Psychosis
INTERVENING EARLY IN PSYCHOSIS: A TEAM APPROACH
2019: 187–209
View details for Web of Science ID 000549765400013
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Special Populations: College and University Students
INTERVENING EARLY IN PSYCHOSIS: A TEAM APPROACH
2019: 403–15
View details for Web of Science ID 000549765400024
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Growth of Early Intervention in Psychosis in the United States
INTERVENING EARLY IN PSYCHOSIS: A TEAM APPROACH
2019: 11–22
View details for Web of Science ID 000549765400003
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Implications of Lifestyle Medicine and Psychiatry for Health Care Systems and Population Health
LIFESTYLE PSYCHIATRY
2019: 353–66
View details for Web of Science ID 000552225000022
- Intervening Early in Psychosis: A Team Approach edited by Hardy, K. V., Ballon, J. S., Noordsy, D. L., Adelsheim, S. American Psychiatric Association Publishing. 2019
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Why Do People With Schizophrenia Exercise? A Mixed Methods Analysis Among Community Dwelling Regular Exercisers.
Frontiers in psychiatry
2018; 9: 596
Abstract
Individuals with schizophrenia have reduced rates of physical activity, yet substantial proportions do engage in independent and regular exercise. Previous studies have shown improvement in symptoms and cognitive function in response to supervised exercise programs in people with schizophrenia. There is little data on motivations of individuals who exercise independently, or their chosen type, duration, or setting of exercise. This study explores motivational parameters and subjective experiences associated with sustained, independent exercise in outpatients with a diagnosis of schizophrenia or schizoaffective disorder. Participants completed a semi-structured interview and then were given a prospective survey containing visual analog scales of symptom severity and the Subjective Exercise Experiences Scales to complete immediately before and after three sessions of exercise. Results from the semi-structured interview were analyzed by modified content analysis. The most important reason for exercise was self-image, followed closely by psychological and physical health. Among psychological effects, participants reported exercise was most helpful for mood and cognitive symptoms. The prospective ratings demonstrated 10-15% average improvements in global well-being, energy, and negative, cognitive and mood symptoms, with almost no change in psychosis, after individual exercise sessions. This suggests that non-psychotic parameters are more susceptible to inter-session decay of exercise effects, which may reinforce continued exercise participation.
View details for DOI 10.3389/fpsyt.2018.00596
View details for PubMedID 30483166
View details for PubMedCentralID PMC6243105
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Genetic Correlation Profile of Schizophrenia Mirrors Epidemiological Results and Suggests Link Between Polygenic and Rare Variant (22q11.2) Cases of Schizophrenia
SCHIZOPHRENIA BULLETIN
2018; 44 (6): 1350–61
View details for DOI 10.1093/schbul/sbx174
View details for Web of Science ID 000456691800023
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Consumer and Family Perspectives on Reducing the Duration of Untreated Psychosis
WILEY. 2018: 62
View details for Web of Science ID 000444798900176
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Clozapine Titration for People in Early Psychosis A Chart Review and Treatment Guideline
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
2018; 38 (3): 234–38
Abstract
The use of clozapine, particularly in young people, is often limited by early treatment-emergent adverse effects including drowsiness and lethargy. Concerns about adverse effects, medication adherence, and the need for blood monitoring often impede the use of clozapine in this population, leading to repeated trials of less effective medications. Current clozapine dosing recommendations are based on people further in the course of their illness and thus reflect different responsiveness and sensitivities to antipsychotic medication. As such, there is a need for evidence-based guidelines for titration and dosing of clozapine among people in early psychosis.We performed a chart review of 14 people treated with clozapine within our early psychosis team. Data regarding dose titration, response, time to discontinuation, symptom severity, weight gain, and other adverse effects were gathered at clozapine initiation, 3 months, and last available visit on clozapine.People treated with slow titration within their first year of psychosis onset achieved sustained response at very low maintenance doses (mean dose = 81 mg/d, mean duration of treatment = 200 weeks) compared with slow titration with longer duration of illness (mean dose = 350 mg/d, mean duration of treatment = 68 weeks) or standard dose titration in early psychosis (mean dose = 112 mg/d, mean duration of treatment = 38 weeks). The most common adverse effects in all groups were weight gain and sedation, with the groups requiring higher mean doses reporting a broader range of adverse effects. There was no apparent difference in the clinical global impression for severity or improvement between the slow titration and standard titration groups in people with early psychosis. These observations are synthesized into a proposed treatment guideline for use of clozapine among people in early psychosis.We describe development of a slow titration approach to initiating clozapine among people in early psychosis. This approach resulted in clinical response at remarkably low maintenance doses of clozapine among people within their first year of illness, but not in those with longer duration of symptoms. Slow titration also led to good tolerability and acceptance of clozapine treatment for some patients.
View details for DOI 10.1097/JCP.0000000000000860
View details for Web of Science ID 000431001500012
View details for PubMedID 29659460
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Therapeutic Potential of Physical Exercise in Early Psychosis
AMERICAN JOURNAL OF PSYCHIATRY
2018; 175 (3): 209–14
View details for DOI 10.1176/appi.ajp.2017.17060716
View details for Web of Science ID 000437289900006
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Therapeutic Potential of Physical Exercise in Early Psychosis.
The American journal of psychiatry
2018; 175 (3): 209–14
View details for PubMedID 29490501
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Psychiatric Evaluation of the Young Adult University Student
STUDENT MENTAL HEALTH: A GUIDE FOR PSYCHIATRISTS, PSYCHOLOGISTS, AND LEADERS SERVING IN HIGHER EDUCATION
2018: 165-183
View details for Web of Science ID 000552225100013
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Student Mental Health
STUDENT MENTAL HEALTH: A GUIDE FOR PSYCHIATRISTS, PSYCHOLOGISTS, AND LEADERS SERVING IN HIGHER EDUCATION
2018: 3–15
View details for Web of Science ID 000552225100003
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Factors motivating spontaneous exercise in individuals with schizophrenia-spectrum disorders.
Schizophrenia research
2018
View details for PubMedID 29656908
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Impact of age of onset of psychosis and engagement in higher education on duration of untreated psychosis
JOURNAL OF MENTAL HEALTH
2018; 27 (3): 257–62
Abstract
The average age of onset of psychosis coincides with the age of college enrollment. Little is known about the impact of educational engagement on DUP in a college-aged population.To determine DUP, and the impact of educational engagement, for college-aged participants of the RAISE study (n = 404).We conducted secondary data analyses on the publicly available RAISE dataset. Subsamples were analyzed to determine the impact of age and educational engagement on DUP.DUP was significantly shorter (p < 0.02) for participants who were college-aged (18-22 years, n = 44) and engaged in post-secondary education (median = 12 weeks, mean = 29 weeks) compared with participants who were college-aged and not engaged in higher education (n = 92, median = 29 weeks, mean = 44 weeks).Educational engagement appears to be associated with a shorter DUP. This may be partially explained by the presence of on-site wellness centers in college settings. However, even among young people who engaged in post-secondary education DUP was still at, or beyond, the upper limit of WHO recommendations in this group. Future research exploring how colleges could improve their capacity to detect and refer at risk students for treatment at an earlier stage is recommended.
View details for PubMedID 29707996
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Risperidone versus olanzapine among patients with schizophrenia participating in supported employment: Eighteen-month outcomes.
Journal of psychiatric research
2017; 95: 299-307
Abstract
This study compares the efficacy and tolerability of olanzapine versus risperidone among patients with schizophrenia who are established in outpatient psychiatric care and entering supported employment. A multicenter, randomized, double-blind trial was conducted among 107 outpatients with schizophrenia, who were cross-titrated to flexible dose risperidone or olanzapine over 2 weeks. Clinical endpoints included time to hospitalization and persistence on assigned medication. Weight, laboratory tests, psychopathology, neurologic side effects, social adjustment and role functioning were assessed at 3-6 month intervals. Data were analyzed first by randomized treatment, and then reassessed controlling for prior medication treatment. The proportion of patients on assigned medication at 18 months was 30.9% for risperidone and 37.3% for olanzapine. Mean doses were 6.4 ± 3.2 mg daily for risperidone, and 17.0 ± 5.0 mg daily for olanzapine. The groups did not differ significantly in time to medication discontinuation, first hospitalization or first employment. There were few differences in psychopathology, laboratory, or neurological assessments between groups at 18 months. Patients randomized to olanzapine gained modestly more weight. Controlling for pre-randomization medication suggested improvement in some aspects of psychopathology from switching medications; however, switching from olanzapine to risperidone was associated with more hospitalizations. Risperidone and olanzapine have similar efficacy and tolerability in patients with schizophrenia who are participating in supported employment. Randomization to olanzapine was associated with more weight gain, but randomization from olanzapine to risperidone appeared to be associated with a greater likelihood of hospitalization. Careful monitoring of metabolic effects and participation in supported employment may have contributed to minimal weight gain and metabolic effects.
View details for DOI 10.1016/j.jpsychires.2017.09.008
View details for PubMedID 28942217
View details for PubMedCentralID PMC5653420
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An RCT Evaluating the Effects of Skills Training and Medication Type on Work Outcomes Among Patients With Schizophrenia
PSYCHIATRIC SERVICES
2017; 68 (3): 271-277
Abstract
Although supported employment increases job acquisition for people with serious mental illness, data on participants' job tenure have been variable. This study evaluated the effects of a standardized work skills training program (the Workplace Fundamentals Module [WPFM]) on job tenure and other work outcomes among individuals receiving individual placement and support (IPS). The effects of two atypical antipsychotic medications on side effects were also tested. The primary hypothesis tested was that participants in IPS plus WPFM would have increased job tenure compared with those enrolled in IPS only, and the secondary hypothesis was that different antipsychotic medications would yield unique side effects.A 2×2 randomized controlled trial compared work outcomes, including job tenure, of participants receiving IPS with or without WPFM for up to two years after obtaining a job. Participants were also randomly assigned to olanzapine or risperidone. Measures of work outcomes, clinical status, and medication side effects were collected.Among 107 participants, 63% obtained at least one job. WPFM did not increase job tenure (51.53 and 41.37 total weeks worked for IPS only and IPS plus WPFM, respectively) or affect other work outcomes. Participants on olanzapine experienced increased body mass index, whereas those on risperidone lost weight, but medications did not differentially affect clinical or job outcomes.Clinic-based skills training did not improve work outcomes accruing from IPS. Risperidone, compared with olanzapine, may reduce body mass but has no differential effect on other work or clinical outcomes.
View details for DOI 10.1176/appi.ps.201500171
View details for Web of Science ID 000397093300012
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GENETIC CORRELATION ANALYSIS OF SCHIZOPHRENIA MIRRORS KNOWN EPIDEMIOLOGICAL RELATIONSHIPS AND SUGGESTS NOVEL ASSOCIATIONS
OXFORD UNIV PRESS. 2017: S73
View details for Web of Science ID 000397126200196
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Risperidone versus olanzapine among patients with schizophrenia participating in supported employment: Eighteen-month outcomes
Journal of Psychiatric Research
2017: 299–307
Abstract
This study compares the efficacy and tolerability of olanzapine versus risperidone among patients with schizophrenia who are established in outpatient psychiatric care and entering supported employment. A multicenter, randomized, double-blind trial was conducted among 107 outpatients with schizophrenia, who were cross-titrated to flexible dose risperidone or olanzapine over 2 weeks. Clinical endpoints included time to hospitalization and persistence on assigned medication. Weight, laboratory tests, psychopathology, neurologic side effects, social adjustment and role functioning were assessed at 3-6 month intervals. Data were analyzed first by randomized treatment, and then reassessed controlling for prior medication treatment. The proportion of patients on assigned medication at 18 months was 30.9% for risperidone and 37.3% for olanzapine. Mean doses were 6.4 ± 3.2 mg daily for risperidone, and 17.0 ± 5.0 mg daily for olanzapine. The groups did not differ significantly in time to medication discontinuation, first hospitalization or first employment. There were few differences in psychopathology, laboratory, or neurological assessments between groups at 18 months. Patients randomized to olanzapine gained modestly more weight. Controlling for pre-randomization medication suggested improvement in some aspects of psychopathology from switching medications; however, switching from olanzapine to risperidone was associated with more hospitalizations. Risperidone and olanzapine have similar efficacy and tolerability in patients with schizophrenia who are participating in supported employment. Randomization to olanzapine was associated with more weight gain, but randomization from olanzapine to risperidone appeared to be associated with a greater likelihood of hospitalization. Careful monitoring of metabolic effects and participation in supported employment may have contributed to minimal weight gain and metabolic effects.
View details for DOI 10.1016/j.jpsychires.2017.09.008
View details for PubMedCentralID PMC5653420
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Treatment of Schizophrenia
AMERICAN PSYCHIATRIC ASSOCIATION PUBLISHING TEXTBOOK OF PSYCHOPHARMACOLOGY, 5TH EDITION
2017: 1241-1281
View details for Web of Science ID 000550981300043
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Genetic Correlation Profile of Schizophrenia Mirrors Epidemiological Results and Suggests Link Between Polygenic and Rare Variant (22q11.2) Cases of Schizophrenia.
Schizophrenia bulletin
2017
Abstract
New methods in genetics research, such as linkage disequilibrium score regression (LDSR), quantify overlap in the common genetic variants that influence diverse phenotypes. It is becoming clear that genetic effects often cut across traditional diagnostic boundaries. Here, we introduce genetic correlation analysis (using LDSR) to a nongeneticist audience and report transdisciplinary discoveries about schizophrenia. This analytical study design used publically available genome wide association study (GWAS) data from approximately 1.5 million individuals. Genetic correlations between schizophrenia and 172 medical, psychiatric, personality, and metabolomic phenotypes were calculated using LDSR, as implemented in LDHub in order to identify known and new genetic correlations. Consistent with previous research, the strongest genetic correlation was with bipolar disorder. Positive genetic correlations were also found between schizophrenia and all other psychiatric phenotypes tested, the personality traits of neuroticism and openness to experience, and cigarette smoking. Novel results were found with medical phenotypes: schizophrenia was negatively genetically correlated with serum citrate, positively correlated with inflammatory bowel disease, and negatively correlated with BMI, hip, and waist circumference. The serum citrate finding provides a potential link between rare cases of schizophrenia (strongly influenced by 22q11.2 deletions) and more typical cases of schizophrenia (with polygenic influences). Overall, these genetic correlation findings match epidemiological findings, suggesting that common variant genetic effects are part of the scaffolding underlying phenotypic comorbidity. The "genetic correlation profile" is a succinct report of shared genetic effects, is easily updated with new information (eg, from future GWAS), and should become part of basic disease knowledge about schizophrenia.
View details for PubMedID 29294133
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Ethical Issues in the Care of People With Schizophrenia.
Focus (American Psychiatric Publishing)
2016; 14 (3): 349-353
View details for DOI 10.1176/appi.focus.20160011
View details for PubMedID 31975817
View details for PubMedCentralID PMC6526796
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Ethical Issues in the Care of People with Schizophrenia
Focus: The Journal of Lifelong Learning in Psychiatry
2016; 14 (3): 349-353
View details for DOI 10.1176/appi.focus.20160011
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Long-Acting Injectable vs Oral Risperidone for Schizophrenia and Co-Occurring Alcohol Use Disorder: A Randomized Trial
JOURNAL OF CLINICAL PSYCHIATRY
2015; 76 (10): 1359-1365
Abstract
Alcohol use disorders worsen the course of schizophrenia. Although the atypical antipsychotic clozapine appears to decrease alcohol use in schizophrenia, risperidone does not. We have proposed that risperidone's relatively potent dopamine D2 receptor blockade may partly underlie its lack of effect on alcohol use. Since long-acting injectable (LAI) risperidone both results in lower average steady-state plasma concentrations than oral risperidone (with lower D2 receptor occupancy) and encourages adherence, it may be more likely to decrease heavy alcohol use (days per week of drinking 5 or more drinks per day) than oral risperidone.Ninety-five patients with DSM-IV-TR diagnoses of schizophrenia and alcohol use disorder were randomized to 6 months of oral or LAI risperidone between 2005 and 2008. Explanatory (efficacy) analyses were carried out to evaluate the potential benefits of LAI under suitably controlled conditions (in contrast to real-world settings), with intent-to-treat analyses being secondary.Explanatory analyses showed that heavy drinking in the oral group worsened over time (P = .024) and that there was a statistical trend toward significance in the difference between the changes in heavy drinking days in the oral and LAI groups (P = .054). Furthermore, the 2 groups differed in the mean number of drinking days per week (P = .035). The intent-to-treat analyses showed no difference in heavy drinking but did show a difference in average drinking days per week similar to that obtained from the explanatory analyses (P = .018). Neither explanatory nor intent-to-treat analyses showed any between-group differences in alcohol use as measured by intensity or the Alcohol Use Scale. The plasma concentrations of the active metabolite 9-hydroxyrisperidone were significantly lower in patients taking LAI (P < .05), despite their significantly (overall) better treatment adherence (P < .005).For the population considered here, schizophrenia patients with alcohol use disorder appear to continue drinking some alcohol while taking either form of risperidone. Nonetheless, our data suggest that injectable risperidone may be a better choice than the oral form for these dual diagnosis patients.ClinicalTrials.gov identifier: NCT00130923.
View details for DOI 10.4088/JCP.13m08838
View details for Web of Science ID 000368347900022
View details for PubMedID 26302441
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Low-Dose Quetiapine Induced or Worsened Mania in the Context of Possible Undertreatment
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
2015; 28 (1): 154-158
Abstract
Bipolar disorder is a mental illness with a lifetime prevalence of 2% and has a dramatic impact on quality of life. Mania is a distinct period of abnormal and sustained elevated, expansive, or irritable mood and increase in goal-directed activity or energy that lasts at least 1 week and is present for most of each day. Quetiapine is an atypical antipsychotic approved for the treatment of bipolar depression and mania. For the treatment of acute mania, a dose of 600 to 800 mg/day is recommended. There has been concern of potential induction or worsening of hypomanic or manic symptoms at low doses via the ratio of 5HT2A/D2 receptor antagonism, which at lower doses favors greater 5HT2A receptor blockade and thus increases dopamine concentrations. This article describes a case report of hypomania worsening to mania with psychotic features in a drug-naïve patient who was started on low-dose quetiapine. This case adds to the existing literature of case reports indicating that low-dose quetiapine may be associated with induction or worsening of hypomanic/manic symptoms, while acknowledging the difficulty of suggesting a causal relationship.
View details for DOI 10.3122/jabfm.2015.01.140105
View details for Web of Science ID 000347880900024
View details for PubMedID 25567837
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Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders.
Current addiction reports
2014; 1 (4): 251-260
Abstract
Substance use disorders, common in patients with schizophrenia, can lead to poor outcomes. Here we review the literature on the use of antipsychotics in patients with co-occurring schizophrenia and substance use disorder as well as evidence for the use of adjunctive pharmacological treatments targeting substance use in these patients. We also discuss a neurobiological formulation suggesting that the cooccurrence of these disorders may be related to a dysfunction in the dopamine mediated brain reward circuitry. Typical antipsychotics do not appear to decrease substance use in this population. Randomized, controlled trials provide some support for use of the atypical antipsychotic clozapine for co-occurring cannabis use disorder, naltrexone and disulfiram for alcohol use disorder, and also nicotine replacement therapy, sustained-release bupropion and varenicline for tobacco use disorder. Nonetheless, data regarding treatment in patients with these co-occurring disorders are still limited, and many studies reported to date have been either underpowered or did not include a control condition. Further research is needed to evaluate optimal pharmacotherapeutic strategies for this population.
View details for PubMedID 27226947
View details for PubMedCentralID PMC4877030
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Neuroleptic Malignant Syndrome During Multiple Antipsychotic Therapy
COMMUNITY MENTAL HEALTH JOURNAL
2013; 49 (1): 45-46
View details for DOI 10.1007/s10597-011-9452-3
View details for Web of Science ID 000313654900006
View details for PubMedID 22038421
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A Randomized Trial of Clozapine Versus Other Antipsychotics for Cannabis Use Disorder in Patients With Schizophrenia
JOURNAL OF DUAL DIAGNOSIS
2011; 7 (1-2): 50-63
Abstract
Cannabis use disorder is the most common co-occurring drug use disorder in people with schizophrenia and is associated with poor outcomes. We launched a randomized controlled trial to assess the impact of clozapine compared with treatment as usual on cannabis use in patients with schizophrenia and co-occurring cannabis use disorder.Thirty-one patients with schizophrenia and co-occurring cannabis use disorder were randomly assigned to switch to clozapine or to stay on their current antipsychotic and were then followed weekly for 12 weeks. Blinded raters assessed participants weekly with the Timeline Follow-back for substance use and the expanded Brief Psychiatric Rating Scale for symptoms. Longitudinal random effects models were used to investigate the time-varying differences in cannabis use and other outcomes between the treatment as usual and clozapine groups.The two groups differed in average intensity of cannabis use by approximately 4.5 joints/week, with lesser use in the clozapine group (t = -1.77; df = 28.5; p=.086; effect size ~ 0.6). Symptoms and functioning were not different between the two groups.Clozapine may reduce cannabis use among patients with schizophrenia and co-occurring cannabis use disorder. Further controlled trials are warranted.
View details for DOI 10.1080/15504263.2011.570118
View details for Web of Science ID 000290671900006
View details for PubMedID 25914610
View details for PubMedCentralID PMC4407140
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Treatment of catatonic schizophrenia with lorazepam and aripiprazole
SCHIZOPHRENIA RESEARCH
2009; 112 (1-3): 194-195
View details for DOI 10.1016/j.schres.2009.04.009
View details for Web of Science ID 000268153900029
View details for PubMedID 19411162
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Six-month outcomes for patients who switched to olanzapine treatment
PSYCHIATRIC SERVICES
2001; 52 (4): 501-507
Abstract
This study evaluated the outcomes of patients in a community mental health center who switched from treatment with another antipsychotic to olanzapine treatment. It also sought to determine whether simultaneous access to case management and psychosocial rehabilitation and olanzapine leads to enhanced functional improvement.Six-month outcomes for a consecutive series of 104 patients who switched from a conventional antipsychotic medication to olanzapine were evaluated. Forty-nine patients in the same treatment program who continued to take conventional antipsychotics were also monitored as a reference group. Outcomes of the group receiving olanzapine were compared with their own baseline status and with outcomes of the reference group.At six months, patients in the olanzapine group demonstrated significant improvement over baseline across multiple measures of symptoms and psychosocial function. Compared with the reference group, the olanzapine group was more symptomatic at baseline and demonstrated significantly greater improvement at follow-up on the Brief Psychiatric Rating Scale and all subscales; Mini Psychiatric Rating Scale negative symptom, disorganization, anxiety, depression, and medication side effects items; and Clinical Global Improvement scale and Case Manager's Rating Scale-Plus illness factors. There was a trend toward superior improvement in psychosocial functioning among patients in the olanzapine group that achieved significance when patients in acute relapse at baseline were excluded.Olanzapine is effective in managing markedly to severely ill patients with psychotic disorders in a community mental health center. Simultaneous treatment with olanzapine, case management, and psychosocial rehabilitation leads to enhanced functional improvement among nonrelapsing patients.
View details for Web of Science ID 000167877100014
View details for PubMedID 11274497