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Biomedical subjects

A G Awad

Publications and source records attributed to A G Awad.

At least 37 records · Page 2Linked to original sources
PubMed1997

The influence of neurocognitive deficits and symptoms on quality of life in schizophrenia.

The purpose of the present study was to examine the relationship between neurocognitive deficits and self-reported quality of life in order to examine whether neurocognitive impairment interferes with any aspects of quality of life for patients with schizophrenia. Forty-two outpatients with stable chronic schizophrenia were assessed for neurocognitive deficits using a computerized test battery, and all patients completed a version of the Sickness Impact Profile (SIP) to assess their quality of life across a variety of domains. The neurocognitive assessment tests revealed significant deficits compared with normal control subjects, particularly with respect to impaired iconic memory and frontal functioning. Patients reported that their quality of life was compromised. Despite the substantiation of marked neurocognitive deficits and reduced quality of life, correlations between neurocognitive deficits and quality of life were largely nonsignificant or very weak. Symptom expression, however, particularly with regard to general psychopathology on the Positive and Negative Syndrome Scale (PANSS), was significantly associated with quality of life. These results suggest that neurocognitive deficits in schizophrenia, while often profound, appear to have little direct impact on the patient's perceived quality of life.

Adult↗
PubMed1997

Quality of life and response of negative symptoms in schizophrenia to haloperidol and the atypical antipsychotic remoxipride. The Canadian Remoxipride Group.

In a large, multicenter, double-blind study of the effect of haloperidol and the atypical antipsychotic remoxipride on improvement of negative symptoms in schizophrenia, quality of life was also assessed using a modified version of the Sickness Impact Profile (SIP). Compared with previous studies, this study had a longer duration (28 weeks), and the dose of the comparator, haloperidol, was much lower. At the end of the study, compared with the baseline, both treatment groups reported comparable improvement in negative symptoms as defined by the protocol (at least 20% improvement). Similarly, both groups showed comparable changes on global and multidimensional self-assessments of quality of life. All the subfactors of the modified version of the SIP were similar in both groups, except for the subfactor that relates to alertness behavior, which possibly reflects remoxipride's lack of any sedating properties compared with haloperidol. This study presents an approach for inclusion of quality of life as an outcome measure in the design of clinical trials of new antipsychotic medications.

Adolescent↗
PubMed1997

Quality of life measurement during antipsychotic drug therapy of schizophrenia.

The strategy for measuring quality of life and the choice of a rating scale should follow a rational scheme aimed at capturing the key components of quality of life of a specified clinical population. This is achieved through defining the purpose of the study, identifying the clinical population and its needs, developing a situation-specific quality of life model, and choosing a battery of psychometrically sound and user-friendly rating scales based on the model. Patients' self-reports and subjective feelings should be central to quality of life measurement, which should also monitor symptom severity, drug side effects, and psychosocial adjustment. This article describes the application of these principles in the context of antipsychotic drug therapy of schizophrenia and identifies potential problems that may arise from the conceptual, psychometric, clinical, and other feasibility issues. The highly subjective nature of the disorder, together with the poor insight, lack of motivation, and neurocognitive deficits of those who are afflicted, poses special difficulties for obtaining and interpreting patients' quality of life appraisals in schizophrenia.

Antipsychotic Agents↗
PubMed1996

Assessment of the patient's subjective experience in acute neuroleptic treatment: implications for compliance and outcome.

The concept of subjective response to neuroleptics in schizophrenia was reviewed with particular focus on scales for its measurement. The significance of recognizing such a phenomenon early on in the course of treatment has been illustrated by research data linking it to compliance, clinical improvement, quality of life, suicidal behaviour and comorbid drug abuse. Negative subjective response to neuroleptics has been identified as a strong predictor of compliance and outcome. Awareness of this subjective response in the management of the acute phase of the illness would require the physician to develop specific or additional approaches to the management of such dysphoric patients on neuroleptics at the time of discharge.

Antipsychotic Agents↗
PubMed1995

Patients' subjective experiences on antipsychotic medications: implications for outcome and quality of life.

The phenomenon of subjective response to antipsychotic medications in schizophrenia was reviewed, focusing on validity, measurement, implications for clinical outcome and quality of life. Recommendations were made on improvements in research approaches to important factors that may contribute to the genesis of this phenomenon. Clinicians should pay attention to the subjective complaints of their patients about medications and not ignore them as unreliable. Researchers should not dismiss research into subjective experiences as non-scientific, because it provides valuable information on recognizing psychopathology and for improving the management of patients.

Antipsychotic Agents↗
PubMed1994

Subjective response to neuroleptics and the quality of life: implications for treatment outcome.

The concept of subjective response to neuroleptics in schizophrenic patients is reviewed in terms of its measurement and validity. Evidence is presented to link negative subjective response to neuroleptics to noncompliance and less favourable therapeutic outcome. The relevance of the construct of subjective responses to neuroleptics is examined in terms of its impact on the functional status and quality of life of patients. There is a great need for improved methods in researching subjective responses as well as better understanding of the factors that contribute to its genesis. The advent of new neuroleptics with superior risk-benefit ratios should encourage such research developments.

Antipsychotic Agents↗
PubMed1993

Neurocognitive subtypes of chronic schizophrenia.

Performance on four key neurocognitive tasks was used to search for subtypes in 104 DSM-IIIR schizophrenic patients. The tasks were the Wisconsin Card Sorting Test to index executive prefrontal cerebral function, intrusion errors from the California Verbal Learning Test to tap hippocampal-diencephalic mnestic function, bilateral hand performance on the Purdue Pegboard to index fine motor-basal ganglial function, and a pro-rated IQ from the Wechsler Adult Intelligence Scale-Revised to measure general cognitive-cerebral function. Neurocognitive data were analyzed using hierarchical and disjoint clustering procedures with Euclidean distance. A five cluster solution was considered optimal. Cluster 1 (n = 24) comprised patients with selective executive-prefrontal dysfunction; cluster 2 (n = 16) suggested normative function; cluster 3 (n = 20) involved patients with executive-motor/cortico-basal ganglial deficit; cluster 4 (n = 25) suggested dementia/multi-focal disturbance; and cluster 5 (n = 19) consisted of patients with selective motor-basal ganglial deficit. The subtypes differed significantly in age, duration of illness, and extent of hospitalization. Suggestive trends in sex composition and anti-Parkinsonian medication patterns were noted. Neurocognitive tasks combined with cluster analysis have promise in reducing and clarifying the heterogeneity of schizophrenia.

Adult↗
PubMed1993

Subjective response to neuroleptics in schizophrenia.

Subjective response to neuroleptics in patients with schizophrenia is reviewed in terms of its validity and measurement. Evidence is presented to support a correlation between altered subjective state on neuroleptics, and therapeutic outcome and medication compliance. Factors that have been implicated in the genesis of such altered subjective states include demographics, psychiatric characteristics, type and dose of neuroleptic, extrapyramidal symptoms (particularly akathisia), depressive states, and patients' values and attitudes toward health and illness. Factors that may contribute to lack of interest in researching subjective experiences of schizophrenia patients on medications are reviewed, and methodological improvements in study design are proposed to enhance our understanding of this phenomenon. Such understanding may help us to better appreciate the many factors that contribute to variability of responses to neuroleptic therapy in patients with schizophrenia and also help us to develop more effective treatment strategies.

Adult↗
PubMed1993

Methodological and design issues in clinical trials of new neuroleptics: an overview.

The recent development of new neuroleptics that differ from the conventional neuroleptics in both mechanism of action and side-effects profile has introduced problems in their clinical assessment, and highlighted ongoing issues in the design and methodology of clinical trials. These issues are broadly grouped and discussed as follows: sampling problems and selection of patients; design issues; problems in measurement; ensuring compliance; recognition of extrapharmacological issues; and statistical models. For patients to benefit from the development of new neuroleptics, clinical settings have to be prepared for testing their efficacy and safety without too much delay in well designed clinical trials.

Antipsychotic Agents↗
PubMed1992

Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures.

The schizophrenic patient's early psychological response to neuroleptic treatment has been demonstrated to be a significant predictor of treatment response. The validity of the construct of subjective response is evaluated by comparison of two measures. Fifty-five recently admitted and unmedicated schizophrenic patients were randomly allocated to chlorpromazine or haloperidol. Subjective responses at 24 and 48 hours as assessed by two different scales, the Van Putten & May scale and the self-administered Drug Attitude Inventory, were strongly correlated with outcome at three weeks. Early emergence of extrapyramidal symptoms was not related to subjective response, but dysphoric patients had a greater incidence of EPS by the end of treatment than did non-dysphoric patients. The two measures showed high concordance in identification of early drug dysphoria.

Adolescent↗
PubMed1992

Quality of life of schizophrenic patients on medications and implications for new drug trials.

The quality of life of schizophrenic patients participating in clinical trials of new neuroleptics is rarely systematically assessed. Factors that may have contributed to the neglect of such assessments include the difficulty of measuring changes affecting quality of life during short-term trials and the continued belief that schizophrenic patients' self-reports about inner states are unreliable. A model of determinants specifically related to the quality of life of schizophrenic patients in such trials would include symptoms, side effects of neuroleptics, and psychosocial performance. In view of the importance of assessing the quality of life of patients on medications, the author recommends that regulatory agencies require such assessments in clinical trials of new neuroleptics.

Activities of Daily Living↗
PubMed1992

The pharmacoepidemiology of treatment-refractory schizophrenia.

Treatment-refractory schizophrenia is a major clinical problem for which there is relatively little scientific information, and no consensus has been reached on approaches to treatment. The pharmacotherapy used for 103 patients with a diagnosis of schizophrenia or schizoaffective disorder at one psychiatric hospital was examined. Data were gathered on neuroleptic choice and dose, the use of adjunctive treatments and serum neuroleptic levels. The daily neuroleptic dose was compared with that of random samples of patients receiving outpatient maintenance treatment, and short-stay patients receiving acute treatment. The patients in our sample received high doses of neuroleptics despite a persistent lack of response to treatment, and despite the fact that these were in excess of the recommended maximum beneficial dose. The appropriateness of this therapy is discussed.

Activities of Daily Living↗
PubMed1991

Psychopharmacology training in psychiatric residency programs: the Canadian scene.

A survey among psychiatric residents about their satisfaction with and concerns about their training in psychopharmacology was conducted. One hundred and seventy responders (61%) from ten post-graduate psychiatric programs in Canada completed the questionnaire. The questionnaire assessed the residents' satisfaction with the training they had received over the previous six months as well as over their entire residency period. The questionnaire inquired specifically about the quantity and quality of supervision in the use of different medications for different therapeutic purposes. It also looked at the quality of supervision of drug therapies within hospital services, inpatient, outpatient, consultation and emergency services. Residents also were asked about coverage of specific topics and ranked different methods of learning. The survey uncovered a number of deficiencies mostly related to the teaching of basic psychopharmacology, integration of psychopharmacological and psychosocial issues and the lack of teaching of clinical appraisal of recent advances. Factors that may have contributed to the development of such deficiencies as well as specific recommendations are discussed.

Attitude of Health Personnel↗
PubMed1990

Selective dopamine D2 antagonist and prolactin response in acute schizophrenia--results from remoxipride studies. The Canadian Remoxipride Study Group.

1. In a double-blind dose finding study prolactin was assessed at baseline and end of treatment in three groups of acute schizophrenics receiving low, intermediate and high doses of remoxipride as compared to a controlled group that received haloperidol. 2. Remoxipride only in high doses (300-600 mg daily) has produced a modest increase in prolactin levels at endpoint as compared to the much higher increase in prolactin secretion that accompanied haloperidol treatment. 3. The weak effects on prolactin as well as the previously reported low incidence of extrapyramidal side effects confirm the profile of remoxipride as a selective dopamine D2 antagonist with preferential effects on the mesolimbic and mesocortical tracts. 4. Male responders to either remoxipride or haloperidol treatment had significantly higher baseline prolactin levels regardless of dose and drug used. In females, there was no difference in baseline prolactin between responders and nonresponders.

Adult↗
PubMed1990

A controlled dose-ranging study of remoxipride and haloperidol in schizophrenia--a Canadian multicentre trial.

The efficacy and side-effect profile for three dose ranges of remoxipride were compared with haloperidol in 242 schizophrenic inpatients in 13 centres. All patients were in a productive phase of schizophrenia according to DSM-III criteria. Relative efficacy of low dose (30-90 mg daily) vs middle dose (120-240 mg daily) vs high dose (300-600 mg daily) was compared with the standard dose of haloperidol (15-45 mg daily), as were the side effects. It was concluded that the therapeutic efficacy of remoxipride was comparable to that of haloperidol for acute episodes of schizophrenia; that the low dose range was significantly less effective than the higher ranges; that there was a clear advantage of remoxipride over haloperidol with respect to incidence and severity of extrapyramidal symptoms. The general safety profile of remoxipride as assessed from clinical chemistry, haematology, and cardiovascular variables suggests that remoxipride in the dose ranges studied can be used safely for the treatment of schizophrenic patients.

Acute Disease↗
PubMed1989

Drug therapy in schizophrenia--variability of outcome and prediction of response.

In spite of the proven benefits of neuroleptics in reducing acute psychotic symptoms and in preventing relapse in schizophrenic patients, not all schizophrenics benefit equally from neuroleptic therapy. Predictors of response include: demographics, clinical characteristics, neurologic soft signs, neurocognitive functioning, morphologic brain changes, drug blood levels, indices of blockade of the dopamine receptors, subjective response to medications as well as early symptomatic improvement. Methodological difficulties in outcome research in drug therapy are reviewed. No single factor has been identified as a reliable predictor of drug response, and it is unlikely that such a single predictor will prove useful in a heterogeneous illness such as schizophrenia. This paper reviews the factors, which have been suggested as useful in developing better understanding of variability of drug response among schizophrenics.

Antipsychotic Agents↗
PubMed1987

Integrating a clinical review process with postgraduate training in clinical psychopharmacology.

The Clinical Psychopharmacology Program at the University of Toronto/Wellesley Hospital uses a clinical review process to train psychiatric residents in the use of psychoactive drugs. Residents participate in setting criteria for proper use of specific drugs and then evaluate their own performance based on those criteria. In addition to improving residents' practices in prescribing psychoactive drugs and monitoring their use, the program introduces future psychiatrists to quality assurance and peer review activities at an early stage.

Drug Utilization↗