Pub Date : 2012-01-01Epub Date: 2012-05-07DOI: 10.1155/2012/764769
Radovan Přikryl, Hana Přikrylová Kučerová, Michaela Vrzalová, Eva Cešková
Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life.
{"title":"Role of long-acting injectable second-generation antipsychotics in the treatment of first-episode schizophrenia: a clinical perspective.","authors":"Radovan Přikryl, Hana Přikrylová Kučerová, Michaela Vrzalová, Eva Cešková","doi":"10.1155/2012/764769","DOIUrl":"https://doi.org/10.1155/2012/764769","url":null,"abstract":"<p><p>Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"764769"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/764769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30895634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-05-07DOI: 10.1155/2012/791468
Christian Asseburg, Michael Willis, Mickael Löthgren, Niko Seppälä, Mika Hakala, Ulf Persson
Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient "mirror-image" study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer hospital episodes per year. The reductions in bed-days per patient-year were similar for patients switched to RLAI as inpatients and as outpatients. In the modelling-based analysis, an 8% reduction in bed-days per year was observed. Conclusion. Despite uncertainty in the choice of analytic approach for allocating inpatient episodes that overlapping this initiation, consistent reductions in resource use are associated with the initiation of RLAI in Finland.
{"title":"Hospitalisation Utilisation and Costs in Schizophrenia Patients in Finland before and after Initiation of Risperidone Long-Acting Injection.","authors":"Christian Asseburg, Michael Willis, Mickael Löthgren, Niko Seppälä, Mika Hakala, Ulf Persson","doi":"10.1155/2012/791468","DOIUrl":"https://doi.org/10.1155/2012/791468","url":null,"abstract":"<p><p>Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient \"mirror-image\" study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer hospital episodes per year. The reductions in bed-days per patient-year were similar for patients switched to RLAI as inpatients and as outpatients. In the modelling-based analysis, an 8% reduction in bed-days per year was observed. Conclusion. Despite uncertainty in the choice of analytic approach for allocating inpatient episodes that overlapping this initiation, consistent reductions in resource use are associated with the initiation of RLAI in Finland.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"791468"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/791468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30895635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-04-05DOI: 10.1155/2012/815315
Cali F Bartholomeusz, Kelly Allott
Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.
{"title":"Neurocognitive and social cognitive approaches for improving functional outcome in early psychosis: theoretical considerations and current state of evidence.","authors":"Cali F Bartholomeusz, Kelly Allott","doi":"10.1155/2012/815315","DOIUrl":"10.1155/2012/815315","url":null,"abstract":"<p><p>Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"815315"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3420601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30896092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-08-14DOI: 10.1155/2012/560836
Borah Kim, Sang-Hyuk Lee, Yen Kuang Yang, Jong-Il Park, Young-Chul Chung
Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent "at any stage." Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.
{"title":"Long-acting injectable antipsychotics for first-episode schizophrenia: the pros and cons.","authors":"Borah Kim, Sang-Hyuk Lee, Yen Kuang Yang, Jong-Il Park, Young-Chul Chung","doi":"10.1155/2012/560836","DOIUrl":"https://doi.org/10.1155/2012/560836","url":null,"abstract":"<p><p>Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent \"at any stage.\" Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"560836"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/560836","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30895629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-08-21DOI: 10.1155/2012/318535
Eduard Parellada, Dawn I Velligan, Robin Emsley, Werner Kissling
Long-acting injectable antipsychotics (LAIAs) may improve adherence to treatment and reduce the rate of relapse and rehospitalization in first-episode or recent-onset schizophrenia (e.g., less than 2 years of illness duration). However, despite their potential advantages, LAIAs are underutilised in clinical practice and the place of LAIAs in the early phases of schizophrenia is still a controversial clinical issue. For example, negative attitudes toward LAIAs in first-episode schizophrenia among psychiatrists are common, and the place of LAIAs for first-episode psychoses (FEPs) remains uncertain in the current clinical guidelines for the pharmacological treatment of schizophrenia. Moreover, a recent paper published in the New England Journal of Medicine by Rosenheck et al. [1] reported negative results of LAI risperidone (RLAI) on relapse prevention, although this was in a multiepisode sample. The recent and forthcoming availability of additional second-generation LAIAs (SG-LAIAs), namely, olanzapine pamoate, paliperidone palmitate, aripiprazole, and iloperidone depot, will add interest to this clinical debate for practicing clinicians and researchers interested in this timely topic.
{"title":"Long-acting injectable antipsychotics in first-episode schizophrenia.","authors":"Eduard Parellada, Dawn I Velligan, Robin Emsley, Werner Kissling","doi":"10.1155/2012/318535","DOIUrl":"https://doi.org/10.1155/2012/318535","url":null,"abstract":"Long-acting injectable antipsychotics (LAIAs) may improve adherence to treatment and reduce the rate of relapse and rehospitalization in first-episode or recent-onset schizophrenia (e.g., less than 2 years of illness duration). However, despite their potential advantages, LAIAs are underutilised in clinical practice and the place of LAIAs in the early phases of schizophrenia is still a controversial clinical issue. For example, negative attitudes toward LAIAs in first-episode schizophrenia among psychiatrists are common, and the place of LAIAs for first-episode psychoses (FEPs) remains uncertain in the current clinical guidelines for the pharmacological treatment of schizophrenia. Moreover, a recent paper published in the New England Journal of Medicine by Rosenheck et al. [1] reported negative results of LAI risperidone (RLAI) on relapse prevention, although this was in a multiepisode sample. The recent and forthcoming availability of additional second-generation LAIAs (SG-LAIAs), namely, olanzapine pamoate, paliperidone palmitate, aripiprazole, and iloperidone depot, will add interest to this clinical debate for practicing clinicians and researchers interested in this timely topic.","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"318535"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/318535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30896704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although response to treatment for the first episode of schizophrenia is generally favourable, nonadherence with the treatment is the first cause of relapse and rehospitalisation within the next few years. Long-acting injectable antipsychotics (LAIAs) combine the advantages of the newer antipsychotics and the long-acting formulation. The evaluation concerns 25 schizophrenic patients hospitalised for the first time, treated with risperidone long-acting injectable (RLAI) associated with reintegration methods, and followed up for at least 18 months. Clinical observation was completed using Clinical Global Impression (CGI) scale and Global Assessment of Functioning (GAF). Clinical improvement was coupled with a good reintegration rate, very few relapse, or rehospitalisation. Bimonthly injection combined with psychosocial methods improved interactive followup, and therefore patients' compliance with the treatment. Treating with LAIA as early as possible, from the first episode if possible, can reduce relapse, number and duration of rehospitalisation, and cognitive symptoms and improve the quality of life and prognosis.
{"title":"Treatment adherence with early prescription of long-acting injectable antipsychotics in recent-onset schizophrenia.","authors":"Annie Viala, Françoise Cornic, Marie-Noëlle Vacheron","doi":"10.1155/2012/368687","DOIUrl":"https://doi.org/10.1155/2012/368687","url":null,"abstract":"<p><p>Although response to treatment for the first episode of schizophrenia is generally favourable, nonadherence with the treatment is the first cause of relapse and rehospitalisation within the next few years. Long-acting injectable antipsychotics (LAIAs) combine the advantages of the newer antipsychotics and the long-acting formulation. The evaluation concerns 25 schizophrenic patients hospitalised for the first time, treated with risperidone long-acting injectable (RLAI) associated with reintegration methods, and followed up for at least 18 months. Clinical observation was completed using Clinical Global Impression (CGI) scale and Global Assessment of Functioning (GAF). Clinical improvement was coupled with a good reintegration rate, very few relapse, or rehospitalisation. Bimonthly injection combined with psychosocial methods improved interactive followup, and therefore patients' compliance with the treatment. Treating with LAIA as early as possible, from the first episode if possible, can reduce relapse, number and duration of rehospitalisation, and cognitive symptoms and improve the quality of life and prognosis.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"368687"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/368687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30896706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-05-20DOI: 10.1155/2012/920485
Cynthia Gayle Wible
Evidence is reviewed for the existence of a core system for moment-to-moment social communication that is based on the perception of dynamic gestures and other social perceptual processes in the temporal-parietal occipital junction (TPJ), including the posterior superior temporal sulcus (PSTS) and surrounding regions. Overactivation of these regions may produce the schizophrenic syndrome. The TPJ plays a key role in the perception and production of dynamic social, emotional, and attentional gestures for the self and others. These include dynamic gestures of the body, face, and eyes as well as audiovisual speech and prosody. Many negative symptoms are characterized by deficits in responding within these domains. Several properties of this system have been discovered through single neuron recording, brain stimulation, neuroimaging, and the study of neurological impairment. These properties map onto the schizophrenic syndrome. The representation of dynamic gestures is multimodal (auditory, visual, and tactile), matching the predominant hallucinatory categories in schizophrenia. Inherent in the perceptual signal of gesture representation is a computation of intention, agency, and anticipation or expectancy (for the self and others). The neurons are also tuned or biased to rapidly detect threat-related emotions. I review preliminary evidence that overactivation of this system can result in schizophrenia.
{"title":"Schizophrenia as a disorder of social communication.","authors":"Cynthia Gayle Wible","doi":"10.1155/2012/920485","DOIUrl":"https://doi.org/10.1155/2012/920485","url":null,"abstract":"<p><p>Evidence is reviewed for the existence of a core system for moment-to-moment social communication that is based on the perception of dynamic gestures and other social perceptual processes in the temporal-parietal occipital junction (TPJ), including the posterior superior temporal sulcus (PSTS) and surrounding regions. Overactivation of these regions may produce the schizophrenic syndrome. The TPJ plays a key role in the perception and production of dynamic social, emotional, and attentional gestures for the self and others. These include dynamic gestures of the body, face, and eyes as well as audiovisual speech and prosody. Many negative symptoms are characterized by deficits in responding within these domains. Several properties of this system have been discovered through single neuron recording, brain stimulation, neuroimaging, and the study of neurological impairment. These properties map onto the schizophrenic syndrome. The representation of dynamic gestures is multimodal (auditory, visual, and tactile), matching the predominant hallucinatory categories in schizophrenia. Inherent in the perceptual signal of gesture representation is a computation of intention, agency, and anticipation or expectancy (for the self and others). The neurons are also tuned or biased to rapidly detect threat-related emotions. I review preliminary evidence that overactivation of this system can result in schizophrenia.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"920485"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/920485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30894429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The theory that many serious mental illnesses, in particular psychoses such as schizophrenia, may have a significant hormonal aetiological component is fast gaining popularity and the support of scientific evidence. Oestrogen in particular has been substantially investigated as a potential mediator of brain function in schizophrenia. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women suggests a protective role of oestrogen. In vitro and in vivo preclinical research confirms oestradiol's interactions with central neurotransmitter systems implicated in the pathogenesis of schizophrenia, while results from randomised controlled trials investigating the antipsychotic potential of oestrogen have been positive. Research into other neuroactive hormones with possible effects on mental state is a rapidly evolving field that may hold new promise. Given that schizophrenia and related psychoses are pervasive and debilitating conditions for which currently available treatments are often only partially effective and entail a high risk of serious side-effects, novel therapeutic strategies are needed. The literature reviewed in this paper suggests that hormones such as oestrogen could be a viable option, and it is hoped that with further research and larger trials, the oestrogen hypothesis can be translated into effective clinical practice.
{"title":"The role of oestrogen and other hormones in the pathophysiology and treatment of schizophrenia.","authors":"Emily Hayes, Emorfia Gavrilidis, Jayashri Kulkarni","doi":"10.1155/2012/540273","DOIUrl":"https://doi.org/10.1155/2012/540273","url":null,"abstract":"<p><p>The theory that many serious mental illnesses, in particular psychoses such as schizophrenia, may have a significant hormonal aetiological component is fast gaining popularity and the support of scientific evidence. Oestrogen in particular has been substantially investigated as a potential mediator of brain function in schizophrenia. Epidemiological and life-cycle data point to significant differences in the incidence and course of schizophrenia between men and women suggests a protective role of oestrogen. In vitro and in vivo preclinical research confirms oestradiol's interactions with central neurotransmitter systems implicated in the pathogenesis of schizophrenia, while results from randomised controlled trials investigating the antipsychotic potential of oestrogen have been positive. Research into other neuroactive hormones with possible effects on mental state is a rapidly evolving field that may hold new promise. Given that schizophrenia and related psychoses are pervasive and debilitating conditions for which currently available treatments are often only partially effective and entail a high risk of serious side-effects, novel therapeutic strategies are needed. The literature reviewed in this paper suggests that hormones such as oestrogen could be a viable option, and it is hoped that with further research and larger trials, the oestrogen hypothesis can be translated into effective clinical practice.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"540273"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/540273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30895628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-02-15DOI: 10.1155/2012/407171
Simon Zhornitsky, Emmanuel Stip
Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part, naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients.
{"title":"Oral versus Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Special Populations at Risk for Treatment Nonadherence: A Systematic Review.","authors":"Simon Zhornitsky, Emmanuel Stip","doi":"10.1155/2012/407171","DOIUrl":"https://doi.org/10.1155/2012/407171","url":null,"abstract":"<p><p>Long-acting injectable antipsychotics (LAIs) should offer better efficacy and tolerability, compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics. However, data on LAIs has been mixed, with some studies finding that they are more effective and tolerable than oral antipsychotics, and others finding the contrary. One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form. The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in randomized and naturalistic studies. In addition, it examined the impact of LAIs on special populations such as patients with first-episode psychosis, substance use disorders, and a history of violence or on involuntary outpatient commitment. Randomized studies suggest that not all LAIs are the same; for example, long-acting risperidone may be associated with equal or less side effects than oral risperidone, whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine. They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia outpatients when combined with quality psychosocial interventions. For their part, naturalistic studies point to a larger magnitude of benefit for LAIs, relative to their oral equivalents particularly among first-episode patients.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"407171"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/407171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30896707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-01-01Epub Date: 2012-04-08DOI: 10.1155/2012/625738
Mahesh Jayaram, Ranganath D Rattehalli, Clive E Adams
Advent of "atypical" antipsychotics has spawned new trials in the recent years and the number of such trial reports has been increasing exponentially. As clinicians we have been led to believe that "atypicals" are better than "typicals" despite the odd dissenting voice in academic and clinical circles. This has been largely ignored until the publication of two landmark, independent, pragmatic trials, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), which proved that thoughtfully chosen "typical" antipsychotics were as good as the newer "atypicals." We pooled "leaving the study early data" from Cochrane Reviews that existed before CATIE and CUtLASS and added data from CATIE and CUtLASS to the pool for a "before and after" comparison. Addition of CATIE and CUtLASS data only led to narrowing of the already existing confidence intervals, merely increasing precision, and decreasing the risk of Type II error. Perhaps surprisingly, CATIE and CUtLASS when pooled with the already existing data showed us that we had chosen to turn a blind eye to findings that already existed. This leads clinicians to question as to whether, in future, we need to feel less guilty about crying out early on that the emperor has no clothes on.
{"title":"Where Does Evidence from New Trials for Schizophrenia Fit with the Existing Evidence: A Case of the Emperor's New Clothes?","authors":"Mahesh Jayaram, Ranganath D Rattehalli, Clive E Adams","doi":"10.1155/2012/625738","DOIUrl":"https://doi.org/10.1155/2012/625738","url":null,"abstract":"<p><p>Advent of \"atypical\" antipsychotics has spawned new trials in the recent years and the number of such trial reports has been increasing exponentially. As clinicians we have been led to believe that \"atypicals\" are better than \"typicals\" despite the odd dissenting voice in academic and clinical circles. This has been largely ignored until the publication of two landmark, independent, pragmatic trials, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), which proved that thoughtfully chosen \"typical\" antipsychotics were as good as the newer \"atypicals.\" We pooled \"leaving the study early data\" from Cochrane Reviews that existed before CATIE and CUtLASS and added data from CATIE and CUtLASS to the pool for a \"before and after\" comparison. Addition of CATIE and CUtLASS data only led to narrowing of the already existing confidence intervals, merely increasing precision, and decreasing the risk of Type II error. Perhaps surprisingly, CATIE and CUtLASS when pooled with the already existing data showed us that we had chosen to turn a blind eye to findings that already existed. This leads clinicians to question as to whether, in future, we need to feel less guilty about crying out early on that the emperor has no clothes on.</p>","PeriodicalId":45388,"journal":{"name":"Schizophrenia Research and Treatment","volume":"2012 ","pages":"625738"},"PeriodicalIF":2.4,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2012/625738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30895631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}