Literature review and economic evaluation of oral and intramuscular ziprasidone treatment among patients with schizophrenia in China

Background Over 10 million Chinese are affected by schizophrenia. The annual cost of schizophrenia in China was estimated at US$2586 per patient.Aims The study has two aims:(1) to conduct a targeted literature review of the economic literature on oral ziprasidone in China, and(2) to develop an inpatient economic model that compared the cost of intramuscular ziprasidone with other regimens including electroconvulsive therapy(ECT) for the management of acute agitation in patients with schizophrenia from a hospital's perspective in China.Methods A targeted literature review was conducted using PubMed and the Chinese literature databases for studies published between January 2007 and December2017. Studies that assessed costs associated with oral ziprasidone treatment for schizophrenia in China were summarised. In the inpatient economic model,cost measures included hospital room and board,antipsychotics,ECT and medications for the management of extrapyramidal symptoms(EPS). Input for standard antipsychotic regimens and unit cost were obtained from the literature. Hospital length of stay(LOS), utilisation of ECT and incidence of EPS were derived from the literature and supplemented/validated with a survey of psychiatrists in China. Cost was presented in 2017 Chinese yuan.Results The average estimated LOS was 29 days with ziprasidone, 33 days with risperidone+benzodiazepine,32 days with olanzapine, 35 days with haloperidol and 29 days with ECT. The cost of antipsychotics was $1260 with ziprasidone, $137 with risperidone+benzodiazepine, $913 with olanzapine and $210 with haloperidol; ECT treatment costs $785. The base-case analysis suggested that higher antipsychotic cost with ziprasidone was offset by savings with shorter LOS. Using intramuscular ziprasidone for acute management was associated with a total cost of $11157, the lowest among all antipsychotic regimens($11 424 with risperidone+benzodiazepine, $11 711 with olanzapine and $11 912 with haloperidol) and slightly higher than ECT($10 606). The cost of antipsychotics and ECT accounted for 1 %-11 % of the total cost. Varying LOS between the lower and upper bounds of the 95% CI, the total cost was comparable between these regimens.Conclusions Overall, the cost for the management of acute agitation was similar between intramuscular ziprasidone and other antipsychotics. Compared with other antipsychotics, the higher medication cost of intramuscular ziprasidone can be offset by savings with shorter hospital stay. The results from this economic analysis were complementary to the findings in the published literature assessing the economic outcomes of oral ziprasidone.

Evaluation of serum indexes and electrophysiological characteristics after ziprasidone combined with modified electroconvulsive therapy for schizophrenian

Objective:To study the effect of ziprasidone combined with modified electroconvulsive therapy (MECT) on serum indexes and electrophysiological characteristics of schizophrenia. Methods: A total of 44 patients with schizophrenia treated in our hospital between May 2014 and July 2016 were selected and randomly divided into MECT group and control group, MECT group received ziprasidone combined with MECT therapy and control group received ziprasidone therapy. Before treatment as well as 1 month, 2 months and 3 months after treatment, serum nerve cytokine levels and inflammatory factor levels as well as nerve electrophysiology parameters were detected.Results: 1 month, 2 months and 3 months after treatment, serum BDNF, GDNF and NGF levels of both groups were significantly higher than those before treatment, IL-1β, IL-6, IL-17 and TNF-α levels were significantly lower than those before treatment, P300 and N2-P3 latency were significantly shorter than those before treatment, and P300 and N2-P3 amplitude were significantly higher than those before treatment;serum BDNF, GDNF and NGF levels of MECT group were significantly higher than those of control group, IL-1β, IL-6, IL-17 and TNF-α levels were significantly lower than those of control group, P300 and N2-P3 latency were significantly shorter than those of control group, and P300 and N2-P3 amplitude were significantly higher than those of control group.Conclusion: Ziprasidone combined with modified electroconvulsive therapy can improve neuron function, reduce neuron damage and adjust nerve electrophysiology function.

A case of severe hyponatremia induced by duloxetine and ziprasidone

We report a case of severe hyponatremia related to duloxetine and ziprasidone. A 50-year-old woman on duloxetine and ziprasidone treatment for major depressive disorder developed polydipsia, polyuria, and two episodes of seizures, followed by admission to the emergency department on the 10th day of treatment. Laboratory investigations revealed elevated creatine kinase （CK） as well as hyponatremia, hypo-osmolality, and increased urine sodium. Syndrome of Inappropriate Antidiuretic Hormone （SIADH） was considered, although urine osmolality was not measured. Duloxetine and ziprasidone were discontinued and the CK gradually normalized after correction of hyponatremia. Clinicians should be aware of the possibility of antipsychotic-induced hyponatremia, particularly in patients with symptoms of polydipsia.

Atypical Neuroleptic Malignant Syndrome: Pitfalls and Challenges in the Delirious Substance Abuser

Introduction: A rare and atypical form of Neuroleptic Malignant Syndrome (NMS) can be a deceptive and life threatening condition if not diagnosed properly in acute and critical care settings. Methods: The management of a patient presenting with atypical NMS without prominent rigidity, but with extensive rhabdomyolysis after the administration of haloperidol and ziprasidone is described in this report. Results: Prompt recognition of atypical features of NMS was managed by intensive care unit admission, supportive care and pharmacotherapy, leading to a complete resolution of the syndrome and a favorable outcome verified by laboratory findings. Conclusion: Early stages and atypical features of NMS may be variable in presentation and clinical course. The absence of muscle rigidity may not rule out NMS. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment. Termination of dantrolene therapy may not be necessary during rhabdomyolysis and elevated aminotransferase levels.