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Stahl S.M.,University of California at San Diego | Stahl S.M.,Neuroscience Education Institute | Malla A.,McGill University | Newcomer J.W.,University of Washington | And 7 more authors.
Journal of Clinical Psychopharmacology | Year: 2010

Schizophrenia is a persistent, lifelong illness such that enduring functional improvements may only occur for years. This post hoc analysis in stable outpatients with schizophrenia investigated the negative symptom efficacy and treatment outcomes of ziprasidone (80-160 mg/d given twice a day, mean modal dose of 112 mg/d; and 80-120 mg/d given every day, mean modal dose of 96 mg/d) versus haloperidol (5-20 mg/d, mean modal dose of 12 mg/d) in a randomized, 40-week, double-blind study, followed by a double-blind continuation trial that extended up to 156 additional weeks. Symptomatic and functional recovery criteria were met when subjects attained both negative symptom remission and adequate psychosocial functioning based on the 4 Quality-of-Life subscales (instrumental role, interpersonal relations, participation in community, and intrapsychic foundations). Negative symptom remission (P = 0.005), as well as sustained adequate functioning (6 months) in instrumental role (P = 0.04) and participation in community (P = 0.02), was associated with significantly shorter time to remission in the ziprasidone 80 to 160 mg group than in the haloperidol group, as was the combination of symptomatic and functional recovery during the 196-week double-blind study period. A similar pattern was observed for the ziprasidone 80 to 120 mg group, which showed significant differences versus haloperidol in negative symptom remission and instrumental role functioning (but not other Quality-of-Life subscale measures). The clinically relevant outcome differences detected in this post hoc exploratory analysis support the potential for both enhanced remission in negative symptoms and psychosocial recovery during long-term treatment with an atypical agent and add to our understanding regarding the degree to which negative symptom remission can be attained in the maintenance phase. © 2010 Lippincott Williams & Wilkins.

Stahl S.M.,Neuroscience Education Institute | Stahl S.M.,University of California at San Diego | Stahl S.M.,University of Cambridge
Journal of Clinical Psychiatry | Year: 2010

Issue: Brain circuits of sexual desire overlap with the known reward pathways. Neurotransmitters, especially dopamine and serotonin, are key regulators of reward. Dysfunction of reward pathways is hypothetically linked to numerous conditions, from depression to substance abuse and, more recently, to sexual dysfunction, including hypoactive sexual desire disorder (HSDD). ©Copyright 2010 Physicians Postgraduate Press, Inc.

Morrissette D.A.,Neuroscience Education Institute | Stahl S.M.,Neuroscience Education Institute | Stahl S.M.,University of California at San Diego
CNS Spectrums | Year: 2012

Antipsychotics are the mainstay of treatment for patients with schizophrenia. However, these medications only work if they are taken and perhaps work best if they are taken for longer periods of time than seen in typical research trials. Here we explore the idea of "time as a drug" by reviewing the data showing the potential benefits of long-term antipsychotic use. We also discuss the utility of depot antipsychotic formulations for improving the chances of attaining long-term therapeutic results. © Cambridge University Press 2012.

Morrissette D.A.,Neuroscience Education Institute | Morrissette D.A.,Palomar College | Stahl S.M.,Neuroscience Education Institute | Stahl S.M.,University of California at San Diego | Stahl S.M.,University of Cambridge
CNS Spectrums | Year: 2013

Insufficient treatment of psychosis often manifests as violent and aggressive behaviors that are dangerous to the patient and others, and that warrant treatment strategies which are not considered first-line, evidence-based practices. Such treatment strategies include both antipsychotic polypharmacy (simultaneous use of 2 antipsychotics) and high-dose antipsychotic monotherapy. Here we discuss the hypothesized neurobiological substrates of various types of violence and aggression, as well as providing arguments for the use of antipsychotic polypharmacy and high-dose monotherapy to target dysfunctional neurocircuitry in the subpopulation of patients that is treatment-resistant, violent, and aggressive. In this review, we focus primarily on the data supporting the use of second-generation, atypical antipsychotics both at high doses and in combination with other antipsychotics. © 2014 Cambridge University Press.

Morrissette D.A.,Neuroscience Education Institute | Morrissette D.A.,California State University, San Marcos | Stahl S.M.,Neuroscience Education Institute | Stahl S.M.,University of California at San Diego
Drug Discovery Today: Therapeutic Strategies | Year: 2012

In addition to positive, negative, aggressive and cognitive symptoms, patients with schizophrenia often exhibit affective disorders, including depression and anxiety. Affective symptoms in schizophrenia can be particularly disturbing for patients with schizophrenia, increasing the risk of suicide and diminishing quality of life. The following review examines the prevalence, etiology and treatment of affective symptoms, particularly depression, in patients with schizophrenia. © 2011 Elsevier Ltd. All rights reserved.

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