A Study of Paliperidone Palmitate 6-Month Formulation
- Conditions
- Schizophrenia
- Interventions
- Drug: PP1MDrug: PP6MDrug: PP3M 350 mg eq.Other: PlaceboDrug: PP3M 525 mg eq.
- Registration Number
- NCT03345342
- Lead Sponsor
- Janssen Research & Development, LLC
- Brief Summary
The purpose of this study is to demonstrate that injection cycles consisting of a single administration of paliperidone palmitate 6-month (PP6M) are not less effective than 2 sequentially administered injections of paliperidone palmitate 3-month PP3M) (350 or 525 mg eq.) for the prevention of relapse in participants with schizophrenia previously stabilized on corresponding doses of paliperidone palmitate 1-month (PP1M) (100 or 150 mg eq.) or PP3M (350 or 525 mg eq.).
- Detailed Description
The primary hypothesis of this study is that the efficacy of PP6M is non-inferior to PP3M for preventing relapse in participants with schizophrenia who were previously stabilized on corresponding doses of PP1M or PP3M. The study consists of mainly 3 phases: a screening phase (up to 28 days), a maintenance phase (of 1 or 3 months), and a double-blind phase (of 12 months \[neither the researchers nor the participants know what treatment the participant is receiving\]). Additional/conditional phases include a transition phase (before maintenance phase). Study evaluations include efficacy, pharmacokinetics, pharmacodynamics, and safety. The study duration will vary from approximately 13 months to 19 months.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 841
- Must meet the diagnostic criteria for schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) for at least 6 months before screening
- Must be receiving treatment with paliperidone palmitate (as either the paliperidone palmitate 1-month (PP1M) or paliperidone palmitate 3-month (PP3M) formulation), or injectable risperidone, or any oral antipsychotic
- Must be able, in the opinion of the investigator, to discontinue any antipsychotic medication other than PP1M) or PP3M during the Screening Phase
- Must have a full Positive and Negative Syndrome Scale (PANSS) score of less than (<) 70 points at screening
- Must have a body mass index (BMI) between 17 and 40 kilogram (kg)/meter (m)^2 (inclusive) and must have a body weight of at least 47 kg at screening
- Must be willing to receive gluteal injections of medication during the Double-blind Phase
Exclusion Criteria
- Must not be receiving any form of involuntary treatment, such as involuntary psychiatric hospitalization, parole-mandated treatment, or court-mandated treatment
- Must not have attempted suicide within 12 months before screening and must not be at imminent risk of suicide or violent behavior, as clinically assessed by the investigator at the time of screening
- Must not have a DSM-5 diagnosis of moderate or severe substance use disorder (except for nicotine and caffeine) within 6 months of screening; however, acute or intermittent substance use prior to screening is not exclusionary, depending upon the clinical judgment of the investigator
- Must not have a history of neuroleptic malignant syndrome or tardive dyskinesia
- Must not have a history of intolerability or severe reactions to moderate or higher doses of antipsychotic medications and must not have any other factors that would, in the judgment of the investigator, indicate that treatment with moderate or higher doses of paliperidone palmitate would be intolerable or unsafe
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description PP1M: Transition Phase PP1M Participants who previously have not achieved stability with moderate to higher doses of Paliperidone palmitate 1-month (PP1M) or Paliperidone palmitate 3-month (PP3M) will enter into a transition period of up to 4 months. During transition period participants will receive 1 to 5 injections of PP1M 50 to 100 milligrams equivalent (mg eq.). The participants who achieved stability (stability is defined as at least 3 months of injections with the last 2 doses being the same strength) with PP1M 100 mg eq. will precede from transition phase to maintenance phase. PP1M/PP3M: Maintenance Phase PP1M All the participants will receive only 1 dose of PP1M 100 or 150 mg eq. or PP3M 350 or 525 mg eq. The participants will precede from maintenance phase to double-blind phase. PP6M or Placebo: Double-Blind Phase PP6M Participants will receive intramuscular injection of PP6M in left gluteal muscle on Day 1 and right gluteal muscle on Day 183 with alternating placebo in right gluteal muscle on Day 92 and left gluteal muscle on Day 274. PP6M or Placebo: Double-Blind Phase Placebo Participants will receive intramuscular injection of PP6M in left gluteal muscle on Day 1 and right gluteal muscle on Day 183 with alternating placebo in right gluteal muscle on Day 92 and left gluteal muscle on Day 274. PP3M: Double-Blind Phase PP3M 350 mg eq. Participants will receive intramuscular injections of PP3M at dose of 350 mg eq. or 525 mg eq. in left gluteal muscle on Day 1 and 274 and right gluteal muscle on Day 92 and 183. PP3M: Double-Blind Phase PP3M 525 mg eq. Participants will receive intramuscular injections of PP3M at dose of 350 mg eq. or 525 mg eq. in left gluteal muscle on Day 1 and 274 and right gluteal muscle on Day 92 and 183. PP1M/PP3M: Maintenance Phase PP3M 350 mg eq. All the participants will receive only 1 dose of PP1M 100 or 150 mg eq. or PP3M 350 or 525 mg eq. The participants will precede from maintenance phase to double-blind phase. PP1M/PP3M: Maintenance Phase PP3M 525 mg eq. All the participants will receive only 1 dose of PP1M 100 or 150 mg eq. or PP3M 350 or 525 mg eq. The participants will precede from maintenance phase to double-blind phase.
- Primary Outcome Measures
Name Time Method Time to Relapse During the Double-Blind (DB) Phase Up to 12 months of DB Phase Time to relapse is time between participant randomization in DB Phase and first documentation of relapse event by end of Month 12 of DB phase. Relapse is defined as: a) Psychiatric hospitalization; b) Positive and Negative Syndrome Scale (PANSS) total score: Increase of 25 percentage (%), 10 point increase in PANSS for 2 analysis separated by 3-7 days if score was greater than (\>) 40, less than or equal to (\<=)40; c) Participants inflicted knowing self-injury/shown violent behavior leading to suicide, clinically significant injury to him/herself or other person/property; d) Participants had suicidal/homicidal ideation/violent behavior that was clinically significant as per investigator; e) PANSS items P1- delusions, P2- conceptual disorganization, P3-hallucinatory behavior, P6- suspiciousness/ persecution, P7-hostility, G8-uncooperativeness: score: greater than or equal to (\>=)5, \>=6 for 2 analysis separated by 3-7 days on any items if maximum score for PANSS: \<=3 or 4, respectively.
- Secondary Outcome Measures
Name Time Method Change From Baseline in the Positive and Negative Syndrome Scale (PANSS) Total Score Baseline (DB) to 12 Months of DB Phase The neuropsychiatric symptoms of schizophrenia were assessed using the 30-item PANSS scale, which provides a total score (sum of the scores for all 30 items) and scores for 3 subscales: the 7-item positive-symptom (P) subscale, the 7-item negative-symptom (N) subscale, and the 16-item general-psychopathology symptom (G) subscale. Each item is rated on a scale from 1 (absent) to 7 (extreme). The PANSS total score ranges from 30 (absent disease)-210 (more severe neuropsychiatric symptoms of schizophrenia).
Change From Baseline in the Clinical Global Impression - Severity (CGI-S) Score Baseline (DB) to 12 Months of DB Phase CGI-S is defined as clinician-rated scale that assesses the severity of mental illness on a scale of 0 to 7. Considering total clinical experience, a participant was assessed on severity of mental illness at the time of rating according to:1: normal, not at all ill; 2: borderline mentally ill; 3: mildly ill; 4: moderately ill; 5: markedly ill; 6: severely ill; 7: among the most extremely ill patients. A higher score implies a more severe condition.
Change From Baseline in the Personal and Social Performance (PSP) Scale Total Score Baseline (DB) to 12 Months of DB Phase The Personal and Social Performance (PSP) scale assesses degree of a participant's dysfunction within 4 domains of behavior: 1) socially useful activities, 2) personal and social relationships, 3) self-care, and 4) disturbing and aggressive behavior. Each domain was assessed on a 6-point scale, from 1 (absent) to 6 (very severe) (1 = absent, 2 = mild, 3 = manifest, 4 = marked, 5 = severe, and 6 = very severe). PSP total score was calculated as sum of all the domain scores and ranges from 1 to 100. Participants with score of 71 to 100 have mild degree of difficulty; from 31 to 70, varying degrees of disability; less than or equal to 30, functioning so poorly as to require intensive supervision. Higher score indicates better performance.
Percentage of Participants With Symptomatic Remission Based on PANSS Score During DB Phase Up to 12 months of DB Phase Symptomatic remission was defined as achieving intensity level of mild or moderate on PANSS scale by all 8 items as the determinants for symptomatic remission: delusions, unusual thought content, hallucinatory behavior, conceptual disorganization, mannerisms/posturing, blunted affect, social withdrawal, lack of spontaneity. The PANSS is a 30-item scale to assess the neuropsychiatric symptoms of schizophrenia (psychiatric disorder with symptoms of emotional instability, detachment from reality, often with delusions and hallucinations, and withdrawal into the self). The PANSS provides a total score and scores for 3 subscales, the positive subscale (7 items), the negative subscale (7 items), and the general psychopathology subscale (16 items), each item scored on a scale of 1 (absent), 2 (minimal), 3 (mild), 4 (moderate), 5 (moderately severe), 6 (severe) and 7 (extreme). The total score ranges from 30 to 210 and higher score indicates greater severity.
Change From Baseline in the Satisfaction With Participants in Social Roles (SPSR) Score Baseline (DB) to 12 Months of DB Phase The SPSR Short Form 8a is a participant-reported outcome used to assess the satisfaction with participation in social roles. The participants were asked to rate 8 items on 5-point Likert scale, with scores ranging from 8 to 40, where higher scores represents higher satisfaction.
Change From Baseline in the Treatment Satisfaction Questionnaire for Medication (TSQM-9) Total Score Baseline (DB) to 12 Months of DB Phase TSQM-9 consists of 9 questions to assess patients' satisfaction with medication using a range of responses from 1 (extremely dissatisfied) to (7 extremely satisfied). This patient reported outcome provides scores on three parts: effectiveness, convenience, and global satisfaction. The sum of the 9-questions were calculated and used for analysis. The total score ranges from 0 to 63, with higher scores indicating better treatment satisfaction.
Change From Baseline in the Simpson-Angus Rating Scale (SAS) Total Score Baseline (DB) to 12 Months of DB Phase The SAS rates 10 items for general extrapyramidal symptoms (EPS) on a 5-point scale from 0 (normal) to 4 (extreme), including gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head rotation, Glabellar tap, tremor, and salivation. The SAS total score is the average score (total sum of item scores divided by the number of items) and ranges between 0 and 4. Negative change in score indicates improvement. Higher scores denote more severe condition of EPS.
Number of Participants With Symptoms of Akathisia Assessed Using Barnes Akathisia Rating Scale (BARS) Score Up to 12 Months of DB Phase BARS is used to rate observable, restless movements of drug induced akathisia and subjective awareness of restlessness and any distress associated with the akathisia. BARS consists of the following 4 items: objective assessment of akathisia symptoms, subjective assessment of the participants's awareness of inner restlessness, distress restlessness, and global clinical assessment of akathisia. First three items are rated on a 4-point scale ranging from 0 (no abnormal movements or absence of inner restlessness or no distress) to 3 (severe akathisia or awareness of intense compulsion to move most of the time or severe distress). The last item, the global clinical assessment of akathisia, is rated on a 6-point scale, ranging from 0 (no evidence of akathisia) to 5 (severe akathisia).
Change From Baseline in the Abnormal Involuntary Movement Scale (AIMS) Total Score Baseline (DB) to 12 Months of DB Phase AIMS is a 14-item scale. Items 1 to 8 are rated on a 5-point scale ranging from 0 (no dyskinetic movements) to 4 (severe dyskinetic movements). Item 9 assesses the participant's incapacitation due to abnormal movements, and item 10 assesses the participant's awareness of the abnormal movements and associated distress. Items 9 and 10 are rated on 5-point scales ranging from 0 (none or no awareness) to 4 (severe or aware, severe distress). Items 11 to 14 are yes/no questions regarding the global judgement and dental status of the participant. The total score is the sum of the scores for the 14 items and the possible total score ranges from 0 to 44. A higher total score is indicative of more severe dyskinetic movements.
Number of Participants Based on Columbia Suicide Severity Rating Scale (C-SSRS) Total Score Baseline and endpoint (12 Months of DB Phase) The C-SSRS is a questionnaire used for suicide risk assessment. Affirmative or negative responses are provided to items 1 to 5 for suicidal ideation (1. Wish to be dead, 2. Non-specific active suicidal thoughts, 3. Active suicidal ideation with any methods \[not plan\] without intent to act, 4. Active suicidal ideation with some intent to act, without specific plan, 5. Active suicidal ideation with specific plan and intent) and items 6 to 10 for suicide behavior (6. Preparatory acts or behavior, 7. Aborted attempt, 8. Interrupted attempt, 9. Actual attempt, 10. Completed suicide). Total score ranges from 1 to 10. Higher scores indicate more severe suicidal ideation.
Number of Participants With Treatment-emergent Abnormal Electrocardiogram (ECG) Values During DB Phase Baseline (DB) to 12 Months of DB Phase Number of participants with treatment-emergent abnormal ECG values were reported. It includes heart rate (abnormally low refers to less than or equal to \[\<=\] 50 beats per minute (bpm) , abnormally high refers greater than or equal to \[\>=\] 100 bpm), pulse rate (PR) interval (abnormally high refers to \>= 210 milliseconds \[msec\]), QRS interval (abnormally Low refers to \<= 50, abnormally high refers to \>= 120 msec) and QT interval (abnormally low refers to \<= 200, abnormally high \>= 500 msec).
Change From Baseline in the Body Mass Index (BMI) During DB Phase Baseline (DB) to 12 Months of DB Phase Change from baseline in BMI was reported.
Change From Baseline in the Waist Circumference During DB Phase Baseline (DB) to 12 Months of DB Phase Change from baseline in waist circumference was reported.
Change From Baseline in the Body Weight During DB Phase Baseline (DB) to 12 Months of DB Phase Change from baseline in body weight was reported.
Change From Baseline in the Vital Signs (Pulse Rate) During DB Phase Baseline (DB) to 12 Months of DB Phase Change from baseline vital signs (pulse rate) were reported. This included supine pulse rate, standing pulse rate and supine-standing pulse rate.
Change From Baseline in the Vital Signs (Systolic Blood Pressure [SBP] and Diastolic Blood Pressure [DBP]) During DB Phase Baseline (DB) to 12 Months of DB Phase Change from baseline in vital signs including SBP and DBP (supine/standing) were reported.
Change From Baseline in Positive and Syndrome Scale (PANSS) Subscales Score During DB Phase Baseline (DB) to 12 Months of DB Phase The neuropsychiatric symptoms of schizophrenia were assessed using the 30-item PANSS scale, which provides a total score (sum of the scores for all 30 items) and Scores for 3 subscales, that is, for positive subscale (sum of the scores of all 7 items) and negative subscale (sum of the scores of all 7 items) ranges from 7 (absent) to 49 (extreme psychopathology), and for the general psychopathology subscale (sum of the scores of all 16 items) score ranges from 16 (absent) to 112 (extreme psychopathology).
Number of Participants With Treatment-emergent Clinically Significant Abnormal Laboratory Values in Hematology During DB Phase Up to 12 Months of DB Phase Number of participants with clinically significant abnormal laboratory values in hematology included hemoglobin (Hb), hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with differential, platelets, hemoglobin A1c. Here, ABL signifies abnormally low and ABH signifies abnormally high levels.
Number of Participants With Treatment-emergent Clinically Significant Abnormal Laboratory Values in Chemistry During DB Phase Up to 12 Months of DB Phase Number of participants with clinically significant abnormal laboratory values in chemistry included alanine aminotransferase (Unit per Litre \[U/L\]), albumin (Gram per Litre \[g/L\]), alkaline phosphatase (U/L), aspartate aminotransferase (U/L), bicarbonate (millimoles per litre \[mmol/L\]), bilirubin (micromoles per litre \[umol/L\]), calcium (mmol/L), chloride (mmol/L), cholesterol (mmol/L), creatinine (umol/L), gamma glutamyl transferase (GGT) (U/L), glucose (mmol/L), high-density lipoproteins (HDL) cholesterol (mmol/L), low density lipoproteins (LDL) cholesterol (mmol/L), lactate dehydrogenase (U/L), phosphate (mmol/L), potassium (mmol/L), protein (mmol/L), sodium (mmol/L), triglycerides (mmol/L), urate (umol/L), urea nitrogen (mmol/L) were reported. Here, ABL signifies abnormally low and ABH signifies abnormally high levels.
Trial Locations
- Locations (138)
New Life Medical Research Center, Inc.
🇺🇸Hialeah, Florida, United States
Atlanta Center for Medical Research
🇺🇸Atlanta, Georgia, United States
Clintex Research Group
🇺🇸Miami, Florida, United States
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
Centro de Estudios Clinicos y Especialidades Medicas, S.C.
🇲🇽Monterrey, Mexico
Poradnia Zdrowia Psychicznego 'Syntonia' w Pruszczu Gdanskim
🇵🇱Pruszcz Gdanski, Poland
CNPE'Kherson Regional Institution of Mental Care'of Kherson Regional Council
🇺🇦Kherson, Ukraine
Jehangir Clinical Development Center Pvt Ltd
🇮🇳Pune, India
Szpital Specjalistyczny im. H. Klimontowicza, Oddzial Psychiatryczny
🇵🇱Gorlice, Poland
Mnpe of Kharkiv Regional Council 'Regional Clinical Psychiatric Hospital #3'
🇺🇦Kharkiv, Ukraine
CEN
🇦🇷Cordoba, Argentina
Psychiatric and Behavioral Solutions
🇺🇸Salt Lake City, Utah, United States
ATP Clinical Research
🇺🇸Costa Mesa, California, United States
Olympian Clinical Research
🇺🇸Tampa, Florida, United States
California Pharmaceutical Research Institute, Inc.
🇺🇸Anaheim, California, United States
Collaborative NeuroScience Network
🇺🇸Garden Grove, California, United States
Synergy East
🇺🇸Lemon Grove, California, United States
Woodland Research Northwest
🇺🇸Rogers, Arkansas, United States
SF-Care, Inc
🇺🇸San Rafael, California, United States
Alexian Behavioral Health Hospital
🇺🇸Hoffman Estates, Illinois, United States
St. Louis Clinical Trials
🇺🇸Saint Louis, Missouri, United States
Wexner Medical Center at the Ohio State University
🇺🇸Columbus, Ohio, United States
University of Pennsylvania Medical Center
🇺🇸Philadelphia, Pennsylvania, United States
Midwest Clinical Research Center
🇺🇸Dayton, Ohio, United States
UMHAT 'Sveti Georgi'-Plovdiv
🇧🇬Plovdiv, Bulgaria
Neuro Trials Victoria
🇦🇺Noble Park, Australia
SPDM - Associacao Paulista para o Desenvolvimento da Medicina - Hospital Sao Paulo
🇧🇷Sao Paulo, Brazil
Fundacion para el Estudio y Tratamiento de las Enfermedades Mentales
🇦🇷Ciudad Autónoma De Buenos Aires, Argentina
Instituto Bairral de Psiquiatria
🇧🇷Itapira, Brazil
Clinica Privada de Salud Mental Santa Teresa de Ávila
🇦🇷La Plata, Argentina
Mental Health Center Prof. Dr. Ivan Temkov
🇧🇬Bourgas, Bulgaria
Psychiatricka ambulance MUDr. Simona Papezova
🇨🇿Prague, Czechia
Centre for Mental Health Prof.N.Shipkovenski EOOD
🇧🇬Sofia, Bulgaria
NeuropsychiatrieHK, s.r.o.
🇨🇿Hradec Kralove-Vekose, Czechia
Medical Center Intermedica, OOD
🇧🇬Sofia, Bulgaria
Bács-Kiskun Megyei Kórház a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktató Kórháza
🇭🇺Kalocsa, Hungary
Centrum Medyczne Luxmed Sp z o o
🇵🇱Lublin, Poland
Infosame/Research
🇲🇽Monterrey, Mexico
Hospital Kuala Lumpur
🇲🇾Kuala Lumpur, Malaysia
Sarawak General Hospital
🇲🇾Kuching, Malaysia
Instituto Neuropsique
🇲🇽Monterrey, Mexico
Psychiatric Clinical hospital 1 named after N.A. Alekseev
🇷🇺Moscow, Russian Federation
Wojewodzki Szpital Zespolony im. L. Rydygiera w Toruniu
🇵🇱Torun, Poland
Saratov Regional Psychiatric hospital named after St. Sofia
🇷🇺Saratov, Russian Federation
Juan Schrönen - Western Cape South Africa
🇿🇦Welgemoed, South Africa
Gert Bosch - Pretoria South Africa
🇿🇦Pretoria, South Africa
Inst. Internac. Neurociencias Aplicadas
🇪🇸Barcelona, Spain
Hosp. Prov. de Zamora
🇪🇸Zamora, Spain
Centro Salud Mental La Corredoria
🇪🇸Oviedo, Spain
Erenkoy Mental Health Hospital
🇹🇷Istanbul, Turkey
CNCE 'Cherkasy Regional Psychiatric Hospital of Cherkasy Regional Council'
🇺🇦Smila, Ukraine
CNCE 'Vinnytsya RC Psychoneurological Hospital n.a. O.I. Yushchenko Vinnytsya RC'
🇺🇦Vinnytsia, Ukraine
Universita degli Studi di Roma 'La Sapienza' - Azienda Ospedaliera Sant Andrea
🇮🇹Roma, Italy
Hospital das Clinicas de Porto Alegre
🇧🇷Porto Alegre, Brazil
CPQuali Pesquisa Clinica LTDA ME
🇧🇷São Paulo, Brazil
Hospital Das Clinicas Da Faculdade De Medicina Da USP
🇧🇷São Paulo, Brazil
Chonnam National University Hospital
🇰🇷Gwangju, Korea, Republic of
Ruschel Medicina e Pesquisa Clínica Ltda
🇧🇷Rio de Janeiro, Brazil
Pacific Research Partners
🇺🇸Oakland, California, United States
Florida Research Center Inc.
🇺🇸Miami, Florida, United States
Uptown Research Institute
🇺🇸Chicago, Illinois, United States
Hosp. El Bierzo
🇪🇸Ponferrada, Spain
Ascension via Christi Research
🇺🇸Wichita, Kansas, United States
Cherry Street Services, Inc.
🇺🇸Grand Rapids, Michigan, United States
The Zucker Hillside Hospital
🇺🇸Glen Oaks, New York, United States
Clinical Trials of America Inc
🇺🇸Hickory, North Carolina, United States
Future Search Trials of Dallas
🇺🇸Dallas, Texas, United States
Sanatorio Prof. Leon S. Morra
🇦🇷Cordoba, Argentina
Instituto de Neurociencias San Agustín
🇦🇷La Plata, Argentina
Trial Tech Tecnologia em Pesquisas com Medicamentos
🇧🇷Curitiba, Brazil
The Lyell McEwin Hospital
🇦🇺Elizabeth Vale, Australia
C.I.A.P. (Centro de investigación y Asistencia en Psiquiatría)
🇦🇷Rosario, Argentina
State Psychiatric Hospital Pazardzhik
🇧🇬Pazardzhik, Bulgaria
State Psychiatric HospitalDr.Georgi Kissiov
🇧🇬Radnevo, Bulgaria
CHU Caremeau
🇫🇷Nimes Cedex 9, France
Psychiatricka ambulance, MUDr. Marta Holanova
🇨🇿Brno, Czechia
C.H.S. Charles Perrens
🇫🇷Bordeaux, France
A-Shine s.r.o.
🇨🇿Plzen, Czechia
Institut Neuropsychiatricke pece
🇨🇿Prague, Czechia
PRAGTIS s.r.o.
🇨🇿Praha 2, Czechia
CHRU La Colombière
🇫🇷Montpellier, France
Hôpital Sainte Musse
🇫🇷Toulon Cedex, France
Hopital Sainte Anne
🇫🇷Paris, France
Kwai Chung Hospital
🇭🇰Hong Kong, Hong Kong
Petz Aladar Megyei Oktato Korhaz
🇭🇺Gyor, Hungary
Queen Mary Hospital
🇭🇰Hong Kong, Hong Kong
Józsefvarosi Szent Kozma Egészségügyi Központ
🇭🇺Budapest, Hungary
CRU Hungary Kft.
🇭🇺Miskolc, Hungary
Ratandeep Multispeciality Hospital
🇮🇳Ahmedabad, India
Asha hospital
🇮🇳Hyderabad, India
Kasturba Medical College Hospital
🇮🇳Manipal, India
Sri Ramachandra Medical Centre
🇮🇳Chennai, India
Ahana Hospitals
🇮🇳Madurai, India
Clinica Psichiatrica - Università di Cagliari
🇮🇹Cagliari, Italy
Deva Institute of Health Care and Research Pvt Ltd
🇮🇳Varanasi, India
Dipartimento di Salute Mentale
🇮🇹Lecce, Italy
Seconda Universita degli Studi di Napoli - Azienda Ospedaliera Universitaria
🇮🇹Napoli, Italy
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
Hospital Bahagia Ulu Kinta
🇲🇾Ipoh, Malaysia
CHA Bundang Medical Center, CHA University
🇰🇷Gyeonggi-do, Korea, Republic of
Chonbuk National Univ Hospital
🇰🇷Jeonju, Korea, Republic of
University Malaya Medical Centre
🇲🇾Kuala Lumpur, Malaysia
Gabipros SC.
🇲🇽Mexico City, Mexico
Centro de Atencion e Investigacion Cardiovascular del Potosi, S.C.
🇲🇽San Luis Potosí, Mexico
Mlynowamed Specjalistyczny Psychiatryczny Gabinet Lekarski Joanna Lazarczyk
🇵🇱Bialystok, Poland
Centrum Badań Klinicznych PI-House sp. z o.o.
🇵🇱Gdansk, Poland
Wlokiennicza MED Specjalistyczna Praktyka Lekarska dr n.med. Tomasz Markowski
🇵🇱Bialystok, Poland
Zespol Opieki Zdrowotnej w Chelmnie
🇵🇱Chelmno, Poland
Mazowieckie Specjalistyczne Centrum Zdrowia im. Prof. Jana Mazurkiewicza w Pruszkowie
🇵🇱Pruszkow, Poland
Niepubliczny Zaklad Opieki Psychiatrycznej MENTIS
🇵🇱Leszno, Poland
Sverdlovsk Regional Clinical Psychiatric Hospital
🇷🇺Ekaterinburg, Russian Federation
SHI 'Saratov City Clinical Hospital 2 n.a V.I. Razumovsky
🇷🇺Saratov, Russian Federation
Clinical Psychiatric Hospital #3 Named After V.A. Gilyarovsky
🇷🇺Moscow, Russian Federation
Nizny Novgorod clinical psychiatric hospital 1
🇷🇺Nizny Novgorod, Russian Federation
Psychoneurological Dispensary of Frunzensky District
🇷🇺St-Petersburg, Russian Federation
Psychoneurological dispensary 1
🇷🇺St-Petersburg, Russian Federation
Psychoneurological dispensary 10
🇷🇺St-Petersburg, Russian Federation
St-Petersburg Bekhterev Psychoneurological Research Institute
🇷🇺St-Petersburg, Russian Federation
Research Institute of Mental Health
🇷🇺Tomsk, Russian Federation
Flexivest 14 Research
🇿🇦Cape Town, South Africa
Psychoneurological Dispensary #4
🇷🇺St.Peterburg, Russian Federation
Hosp. Univ. Vall D Hebron
🇪🇸Barcelona, Spain
Hosp. Univ. de Basurto
🇪🇸Bilbao, Spain
Hosp. Clinico Univ. de Valencia
🇪🇸Valencia, Spain
Mackay Memorial Hospital
🇨🇳Taipei, Taiwan
National Cheng Kung University Hospital
🇨🇳Tainan, Taiwan
Chang Gung Memorial Hospital
🇨🇳Taoyuan, Taiwan
Abdurrah Yurtarslan Training and Research Hospital
🇹🇷Ankara, Turkey
Ankara Numune Research and Training Hospital
🇹🇷Ankara, Turkey
Sakarya University Medical Faculty Psychiatry Department
🇹🇷Sakarya, Turkey
Selcuk University, Medical School, Department of Psychiatry
🇹🇷Konya, Turkey
MNCE of Kyiv RC Regional Psychiatric and Narcological Medical Association
🇺🇦Glevakha, Ukraine
Municipal Institution 'Lviv Regional Clinical Psycho-Neurological Dispensary'
🇺🇦Lviv, Ukraine
CNCE of the Lviv Regional Council 'Lviv Regional Clinical Psychiatric Hospital'
🇺🇦Lviv, Ukraine
Kyiv Territorial Medical Incorporation 'Psychiatry'
🇺🇦Kyiv, Ukraine
CNCE Odesa regional psychiatric hospital #2 Odesa regional council
🇺🇦Oleksandrivka, Ukraine
Vinaya Hospital and Research Center
🇮🇳Mangalore, India
Taipei Veterans General Hospital
🇨🇳Taipei, Taiwan