Chronic ambulatory outpatients and four-vector management.
(25/7917)
Many psychiatrist and other mental healthcare professionals consider the availability of atypical antipsychotic drugs a welcome advance in the treatment of schizophrenia. Atypical agents have show to be effective against both positive and negative symptoms of schizophrenia, and in general, their efficacy makes patients more responsive to rehabilitation efforts. Although drugs are a cornerstone of treatment, optimal management of chronic ambulatory outpatients with schizophrenia also depends of psychosocial and other approaches. Still, noncompliance needs to be addressed as schizophrenia patients often fail to take their medications for a variety of reasons, including undesirable side effects and lack of insight or denial of having a mental disorder. A four-vector model for optimal management of chronic ambulatory outpatients includes the biological, psychological, social, and spiritual domains. Although the resources for providing comprehensive, forward-looking management are not universally available in many areas of the United States, clinicians should always strive for the ideal. (+info)
Atypical antipsychotics in the managed care era.
(26/7917)
Over the past decade, a new class of atypical antipsychotic drugs has been developed for the treatment of schizophrenia and related conditions. This new generation of antipsychotic agents represents the first significant breakthrough in the treatment of schizophrenia since the advent of chlorpromazine in the early 1950s. Although the designation "atypical" is currently the most widely used term for referring to these drugs, they are not likely to be viewed as atypical in the future--given their rapidly increasing use as first-line agents. Increased acceptance of these drugs early in the course of schizophrenia holds the promise of real long-term benefits in outcome. Although the acquisition cost of these drugs is significantly higher than that of older agents, pharmacoeconomic analysis suggests the possibility of substantial reductions in the overall financial burden posed by schizophrenic illness. This review summarizes the role of atypical antipsychotics in the treatment of schizophrenia, their merits compared to conventional medications, and their cost effectiveness. (+info)
Atypical antipsychotics and formulary decisions.
(27/7917)
Although drug costs are a small fraction of the total direct costs of treating schizophrenia, managed care has focused on drug acquisition costs as an area of concern. There is pressure to demonstrate by outcome measures that the increased cost of the newer atypical antipsychotics versus traditional neuroleptics is justified. Decision makers want to be convinced that newer, more expensive treatment translates to value. Evidence accumulated to date suggests that the atypical agents are cost-effective. Studies show patients taking atypical antipsychotics have an improved quality of life, are more easily rehabilitated and reintegrated into the community, return to full- or part-time work more often, and prefer the newer agents to conventional antipsychotics. These benefits have been shown in studies of olanzapine versus haloperidol. Just as important, patients taking atypical antipsychotics show decreased medical care resource utilization, which results in cost savings. (+info)
Ziprasidone 80 mg/day and 160 mg/day in the acute exacerbation of schizophrenia and schizoaffective disorder: a 6-week placebo-controlled trial. Ziprasidone Study Group.
(28/7917)
In this double-blind study, patients with an acute exacerbation of schizophrenia or schizoaffective disorder were randomized to receive either ziprasidone 80 mg/day (n = 106) or 160 mg/day (n = 104) or placebo (n = 92), for 6 weeks. Both doses of ziprasidone were statistically significantly more effective than placebo in improving the PANSS total, BPRS total, BPRS core items, CGI-S, and PANSS negative subscale scores (p < .05). Ziprasidone 160 mg/day significantly improved depressive symptoms in patients with clinically significant depression at baseline (MADRS > or = 14, over-all mean 23.5) (p < .05) as compared with placebo. The percentage of patients experiencing adverse events was similar in each treatment group, and resultant discontinuation was rare. The most frequent adverse events associated with ziprasidone were generally mild dyspepsia, nausea, dizziness, and transient somnolence. Ziprasidone was shown to have a very low liability for inducing movement disorders and weight gain. The results indicate that ziprasidone is effective and well tolerated in the treatment of the positive, negative, and depressive symptoms of an acute exacerbation of schizophrenia or schizoaffective disorder. (+info)
No evidence for involvement of KCNN3 (hSKCa3) potassium channel gene in familial and isolated cases of schizophrenia.
(29/7917)
Several studies have reported in schizophrenia a decrease of age of onset in successive family generations, and this observation is consistent with anticipation. Anticipation is known to result from expansion of CAG repeats in several neurodegenerative disorders. Longer alleles of the KCNN3 gene, which contains a highly polymorphic CAG repeat, and encodes a neuronal small conductance calcium-activated potassium channel, have recently been shown to be over-represented in sporadic cases of schizophrenia. In this report, we tested the hypothesis of an association between longer alleles of CAG repeat in the KCNN3 gene and schizophrenia in 20 families with clinical evidence for anticipation and in 151 unrelated schizophrenic cases. No significant difference in the distributions of allele frequencies was observed between familial cases of schizophrenia and controls, and between unrelated cases and controls. Furthermore, no intergenerational CAG repeat instability was detected in the 20 families. Our results do not support the involvement of the KCNN3 (hSKCa3) gene in the etiology of schizophrenia. (+info)
Randomized controlled trial of teaching practice nurses to carry out structured assessments of patients receiving depot antipsychotic injections.
(30/7917)
BACKGROUND: A third of patients with schizophrenia are out of contact with secondary services. Many of these patients receive maintenance medication as depot antipsychotics from practice nurses, most of whom have negligible training in mental health. AIM: To examine the impact of a structured assessment on the process of care and clinical status of schizophrenia patients by practice nurses who received a one-day training course. METHOD: All identified patients were randomly allocated to structured assessments and outcome, measured by the number of assessments and the changes in care recorded in primary care notes. A comprehensive assessment of clinical and social functioning and level of unmet need in intervention and control patients was carried out after one year by an independent researcher. RESULTS: A high rate of consultation and clinical need in this patient group was demonstrated. Practice nurses were more diligent in carrying out assessments than general practitioners (GPs), but there was no impact on treatment patterns or clinical outcome. CONCLUSIONS: Structured assessments by practice nurses are feasible with this patient group, but training, targeted at both nurses and GPs, is needed if this intervention is to translate into health gain. (+info)
Psychophysical isolation of a motion-processing deficit in schizophrenics and their relatives and its association with impaired smooth pursuit.
(31/7917)
Schizophrenia patients and many of their relatives show impaired smooth pursuit eye tracking. The brain mechanisms underlying this impairment are not yet known, but because reduced open-loop acceleration and closed-loop gain accompany it, compromised perceptual processing of motion signals is implicated. A previous study showed that motion discrimination is impaired in schizophrenia patients. Motion discrimination can make use of position and contrast as well as velocity cues. Here, we report that the motion discrimination deficit, which occurs in both schizophrenic patients and in their first-degree relatives, involves a failure of velocity detection, which appears when judging intermediate target velocities. At slower and faster velocities, judgments of velocity discrimination seemed normal until we experimentally disentangled velocity cues from nonmotion cues. We further report that compromised velocity discrimination is associated with sluggish initiation of smooth pursuit. These findings point to specific central nervous system correlates of schizophrenic pathophysiology. (+info)
Impairment of willed actions and use of advance information for movement preparation in schizophrenia.
(32/7917)
OBJECTIVES: To assess willed actions in patients with schizophrenia using reaction time (RT) tasks that differ in the degree to which they involve volitionally controlled versus stimulus driven responses. METHODS: Ten patients diagnosed with schizophrenia and 13 normal controls of comparable age were tested. Subjects performed a visual simple RT (SRT), an uncued four choice reaction time (CRT), and a fully cued four choice RT task. A stimulus 1(S1)-stimulus 2(S2) paradigm was used. The warning signal/precue (S1) preceded the imperative stimulus (S2) by either 0 (no warning signal or precue) 200, 800, 1600, or 3200 ms. RESULTS: The patients with schizophrenia had significantly slower RTs and movement times than normal subjects across all RT tasks. The unwarned SRT trials were significantly faster than the uncued CRT trials for both groups. For both groups, fully cued CRTs were significantly faster than the uncued CRTs. However, the S1-S2 interval had a differential effect on CRTs in the two groups. For the normal subjects fully cued CRTs and SRTs were equivalent when S1-S2 intervals were 800 ms or longer. A similar pattern of effects was not seen in the patients with schizophrenia, for whom the fully cued CRT were unexpectedly equivalent to SRT for the 200 ms interval and expectedly for the 1600 ms S1-S2 interval, but not the 3200 or 800 ms intervals. CONCLUSIONS: Patients with schizophrenia were able to use advance information inherent in SRT or provided by the precue in fully cued CRT to speed up RT relative to uncued CRT. However, in the latter task, in which the volitional demands of preprogramming are higher since a different response has to be prepared on each trial, patients showed some unusual and inconsistent interval effects suggesting instability of attentional set. It is possible that future studies using RT tasks with higher volitional demands in patients with predominance of negative signs may disclose greater deficits in willed action in schizophrenia. (+info)