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Biomedical subjects

D Naber

Publications and source records attributed to D Naber.

At least 19 recordsLinked to original sources
PubMed2006

What would the patient choose? Subjective comparison of atypical and typical neuroleptics.

INTRODUCTION: Among the advantages of atypical antipsychotics, the lack of motor symptoms and the improvement of negative, affective, and cognitive symptoms are of clinical relevance. The aim of this study was to compare atypical and typical neuroleptics from the patient's perspective. METHOD: To investigate differential efficacy and side effects of neuroleptics, 61 patients with schizophrenia or schizoaffective disorder, who have received typicals for 129 (+/- 194) and atypicals for 53 (+/- 68) weeks, were assessed. RESULTS: There is strong evidence in favor of atypical neuroleptics in the domains negative ( t = 7.7; P < 0.001), cognitive ( t = 10.2; P < 0.001), and affective ( t = 5.5; P < 0.001) symptoms. The assessment of atypicals and typicals regarding positive symptoms did not differ and may be an indication of the validity of the patient's opinion. Regarding tolerability, atypical neuroleptics again are favored because of fewer motor, sexual, and vegetative side effects ( t = 4.2; P < 0.001). DISCUSSION: This study focusing on the subjective experience of patients provides further argument in support of the superiority of atypical over typical neuroleptics. The results of this study also point to the benefits of a consumer-orientated view.

Adult↗
PubMed2006

Gender-specific effects in the treatment of acute schizophrenia with risperidone.

INTRODUCTION: Gender-related effects play a role in antipsychotic treatment. We recently published a study demonstrating the efficacy of the atypical antipsychotic risperidone in the management of acute psychotic decompensations. We have now reanalysed the clinical data to assess the effects of gender on treatment and outcome. METHODS: High-dose treatment with risperidone (6-8 mg/d) was administered to 23 male and 25 female acutely psychotic schizophrenic admissions. PANSS- and CGI-ratings were obtained for four weeks. RESULTS: Males and females did not differ significantly in age, duration of treatment, dose of risperidone or clinical ratings. Females were treated with a significantly higher maximum dose of risperidone per kg body-weight. Significantly more females (n=14) than males (n=8) discontinued the use of risperidone. CONCLUSION: Although the reasons for the lower drop-out rate in males are not clear, gender differences in the clinical presentation may have contributed. High-dose treatment with risperidone may be more beneficial in males for the treatment of acute schizophrenia.

Acute Disease↗
PubMed2005

[Treatment oriented to subjective well- being rather than symptom amelioration "at all costs"--paradigm change in treatment with antipsychotics].

Modern antipsychotics differ from the classical drugs mainly in their improved efficacy in combating affective, negative and cognitive symptoms and by a modified side effect profile. The variability range of such substances enable a more differentiated approach to treatment to be adopted. Patients treated with typical antipsychotics report a more pronounced improvement in subjective well-being. In view of the increasing numbers of atypical antipsychotics, the involvement of the patients in the selection of the most appropriate drug is a must. Apart from symptom amelioration - the formerly predominant goal of treatment - greater emphasis is now placed on the well-being of the individual patient on antipsychotic therapy. With this approach, the physician-patient relationship, compliance and the long-term prognosis can all be appreciably improved.

Adaptation, Psychological↗
PubMed2005

[Identification of possible cognizance parameters of "mimic disintegration" in schizophrenia using facial electromyography].

UNLABELLED: The aim of this study was to identify signs of "mimic disintegration" in schizophrenics using a facial electromyographic (EMG) method. We compared a group of 20 unmedicated schizophrenics with a group of 20 healthy subjects, measuring the activity of three joy-relevant facial muscles (zygomaticus major, orbicularis oculi, levator labii superioris) and two nonjoy-relevant facial muscles (frontalis, corrugator supercilii) as control muscles during two consecutive presentations of an erotic slide from the International Affective Picture System. RESULT: Schizophrenics show significantly less activity of joy-relevant facial muscles and a lower smile frequency than healthy subjects. Two signs of mimic disintegration" could be identified: 1. undefined mimic reactions and 2. lack of mimic consistency. CONCLUSION: Facial EMG is a state-of-the-art method for analyzing possible signs of mimic disintegration as described by Heimann and Spoerri. We suggest further examination of the two mimic disintegration signs regarding other emotions, necessarily including more facial muscles in the testing.

Adult↗
PubMed2005

A simple switching strategy for inadequately treated patients with schizophrenia to olanzapine: changes in psychopathology and subjective well-being.

INTRODUCTION: The aim of the study was to assess the feasibility of abruptly switching inadequately treated psychotic outpatients from another oral antipsychotic to olanzapine and to evaluate subjective well-being under olanzapine. METHODS: Previous medication was switched to olanzapine 10 mg/day and continued for 4 weeks (5-20 mg/day). Successful switch was predefined as no change or any improvement on the Clinical Global Impression-Improvement (CGI-I) scale after one week. A successful switch rate of > or = 70 % was considered a positive study outcome. Well-being was evaluated using the Subjective Well-being under Neuroleptics (SWN) scale. RESULTS: 198 patients (100 %) were switched to olanzapine. In 177 patients (89 %), CGI-I was unchanged (29 %) or improved (60 %) after one week of olanzapine treatment, indicating a positive study outcome (p < 0.001). SWN total score significantly improved from 127.9 (+/- 32.5) at baseline to 139.2 (+/- 31.5) at week 1, continuing to 149.3 (+/- 30.3) at week 4 (LOCF). DISCUSSION: The findings suggest that an abrupt switch from another antipsychotic to olanzapine 10 mg/day can be performed successfully in psychotic patients, while rapidly improving subjective well-being.

Adolescent↗
PubMed2005

Comparison of olanzapine and risperidone in 367 first-episode patients with non-affective or affective psychosis: results of an open retrospective medical record study.

INTRODUCTION: Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis. METHODS: The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level). RESULTS: 367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms ( p = .054) and a shorter treatment duration to reach this remission in affective FEP patients ( p = .077). More extrapyramidal side effects ( p <.001) were related to RIS and more weight gain to OLZ-treatment ( p <.001). DISCUSSION: Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.

Adolescent↗
PubMed2005

Olanzapine vs. other antipsychotics in actual out-patient settings: six months tolerability results from the European Schizophrenia Out-patient Health Outcomes study.

OBJECTIVE: The European Schizophrenia Out-patient Health Outcomes study is an observational study investigating treatment in schizophrenia. We report treatment-emergent adverse events during the first 6 months of treatment. METHOD: The rate of extrapyramidal symptoms (EPS), anticholinergic use, weight gain and sexual related dysfunctions were assessed in 8,400 out-patients. RESULTS: Patients typical antipsychotics and risperidone experienced significantly more EPS and anticholinergic use than patients in the clozapine, olanzapine, and quetiapine cohorts. Patients treated with amisulpride, typical antipsychotics and risperidone were significantly more likely to have sexual related dysfunctions and/or amenorrhea. Increases in weight and body mass index occurred in all cohorts, but were significantly greater in the olanzapine and clozapine cohorts. CONCLUSION: Patients treated with olanzapine, quetiapine and clozapine had better tolerability outcomes regarding EPS and sexual related dysfunctions compared with patients receiving risperidone, amisulpride and typicals. Patients treated with olanzapine and clozapine had higher weight increases than patients treated with risperidone, quetiapine and typicals.

Adult↗
PubMed2005

Randomized double blind comparison of olanzapine vs. clozapine on subjective well-being and clinical outcome in patients with schizophrenia.

OBJECTIVE: This randomized double-blind multicenter trial evaluated the effects of olanzapine vs. clozapine on subjective well-being, quality of life (QOL) and clinical outcome. METHOD: The primary objective was to demonstrate non-inferiority of olanzapine, mean dosage 16.2 +/- 4.8 (5-25 mg/day) vs. clozapine, mean dosage 209 +/- 91 (100-400 mg/day) regarding improvement on the 'Subjective Well-Being under Neuroleptic Treatment' (SWN) Scale after 26 treatment weeks in 114 patients with schizophrenia. Secondary outcome parameters included: Munich QOL Dimension List (MLDL), Positive and Negative Symptom Scale (PANSS), Clinical Global Impression (CGI). RESULTS: SWN scores improved significantly in both groups, olanzapine was non-inferior to clozapine (group difference 3.2 points in favor of olanzapine; 95% CI: 4.2;10.5). MLDL-satisfaction, PANSS and CGI-S improved similarly, olanzapine yielded a higher CGI Therapeutic Index. Individual SWN and PANSS changes correlated only moderately (r = -0.45). CONCLUSION: Olanzapine was non-inferior to clozapine. The lack of a marked correlation between PANSS and SWN improvements indicates that patients and psychiatrists perceive treatment differently.

Adolescent↗
PubMed2005

Subjective well-being under the neuroleptic treatment and its relevance for compliance.

OBJECTIVE: To review the concept of 'subjective well-being under neuroleptic treatment', its development and clinical relevance,particularly regarding compliance. METHOD: The manuscript includes a review of the limited literature and recent open and controlled clinical trials. RESULTS: The patients' perspective of antipsychotic treatment was largely neglected for a long time. Scientific interest in this field of strong clinical relevance started mainly with the development of atypical antipsychotics. Recent research indicates that subjective well-being (SW) is a major determinant of medication compliance in schizophrenia. There are several self-report instruments with sufficient internal consistency and good construct validity. Effects of antipsychotic treatment on psychopathology and SW are only partly related. Most patients strongly prefer the atypical over typical antipsychotics. The assessment of SW is helpful for selecting the optimal drug for the individual patient. CONCLUSION: SW, under antipsychotic treatment, is a valid construct; its assessment provides an independent outcome variable, which is relevant to compliance.

Antipsychotic Agents↗
PubMed2005

The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis.

OBJECTIVE: Studies investigating the impact of comorbid substance use disorders (SUD) in psychosis have tended to focus on cross-sectional data, with few studies examining the effects of substance use course on clinical outcome. The main aim of the present study was to assess the impact of baseline SUD and course of SUD on remission of positive symptoms. METHOD: The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis (FEP) patients between 1998 and 2000. Data on SUD and clinical outcome were collected from patients' medical records (MR) of 643 patients who met inclusion criteria. RESULTS: Lifetime prevalence of SUD was 74%, with 62% having a SUD at baseline. This reduced to 36% in those patients who completed 18 months of treatment at the EPPIC program. A Cox regression analysis indicated that a decrease or cessation of substance use significantly increased the probability of remission, whilst persistent SUD substantially reduced the likelihood. In addition, patients who reduced use appeared to have better outcomes at 18 months than those patients who had never used substances. Baseline SUD was not found to have any significant influence on symptom remission. CONCLUSION: Patients presenting with FEP have high rates of SUD. Effective management of psychosis within a specialized service is associated with reductions in SUD over the course of treatment, although persistent substance use is associated with non-compliance, treatment drop-out and poor remission rates. As such, young people with FEP and comorbid substance use should be offered integrated treatment that addresses both disorders.

Adult↗
PubMed2004

[Atypical antipsychotics in therapy refractory schizophrenia].

Many studies have shown that treatment resistance is a substantial problem in schizophrenic patients, with 20-30% of patients responding only partially and about 7% showing no response to antipsychotic treatment. Clozapine has been consistently shown to be effective in this subgroup of schizophrenic patients. It is still the drug of choice, despite the restricted indication and the need for a careful evaluation of side effects. Recently, several double-blind studies of newer atypical antipsychotics have been conducted in therapy-resistant patients. Three studies compared risperidone with clozapine, one study zotepine with clozapine and two others olanzapine with dozapine. One study compared the efficacy of clozapine, olanzapine, risperidone with one another and with haloperidol. In these studies, dozapine showed increasing superiority the more restrictive the criteria for therapy-resistance chosen. Olanzapine was found to be as effective as clozapine and was better tolerated. However, the results of studies comparing different atypical anti-psychotics have to be interpreted carefully because of their limited number as well as methodological problems. Case studies also indicate the efficacy of combining different atypical antipsychotics, but no systematic research on this issue has been done so far.

Antipsychotic Agents↗
PubMed2004

Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence.

OBJECTIVE: (1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence. METHODS: The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment. RESULTS: The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P < 0.001), extrapyramidal (P < 0.05) and psychic side effects (P < 0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P < 0.05), were more doubtful about their efficacy (P < 0.01) and were less likely to encourage a relative to take such a medication in case of need (P < 0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects. CONCLUSIONS: All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

Adult↗
PubMed2003

CSF-tau, CSF-Abeta1-42, ApoE-genotype and clinical parameters in the diagnosis of Alzheimer's disease: combination of CSF-tau and MMSE yields highest sensitivity and specificity.

This study evaluated the sensitivity and specificity of the cerebrospinal fluid (CSF) levels of tau-protein, amyloid-beta-peptide 1-42 (Abeta1-42), ApoE-genotype and the degree of cognitive decline as diagnostic markers for Alzheimer's disease (AD). Data was obtained from 105 AD patients and 68 controls. Median CSF-tau levels were increased (512 pg/ml vs. 145 pg/ml, p<0.001) and Abeta1-42-levels were decreased (238.5 pg/ml vs. 310 pg/ml, p<0.001) in AD patients compared to controls. A weak correlation was found between CSF-Abeta1-42 and MMSE score (r=.245). Within all subjects, a correlation of CSF-Abeta1-42 (r=-.337) and CSF-tau (r=.384) with age was found. The combination of CSF-tau levels and MMSE revealed the highest sensitivity (92%) and specificity (87%). In summary, CSF-tau was a useful biological marker to discriminate AD from normal aging, neurological and psychiatric disorders. CSF-Abeta1-42 showed no additional benefit in discriminating patients from controls but might be useful for tracking the severity of the disease.

Adolescent↗
PubMed2003

Subjective well-being and initial dysphoric reaction under antipsychotic drugs - concepts, measurement and clinical relevance.

Since the introduction of neuroleptics in 1952, many studies have examined objective aspects of efficacy and tolerability. Despite the fact that neuroleptic treatment should also improve the patient's subjective experiences, this outcome criterion has been neglected in the past. This is unfortunate, as subjective well-being with treatment appears to be strongly related to patients' readiness to take their medication. The few existing studies differ in methodology and are difficult to compare due to a number of weaknesses, including varying underlying concepts, used assessment scales, or small sample sizes. Negative subjective well-being may manifest itself throughout the entire neuroleptic treatment, even as early as in the first 48 hours after neuroleptic treatment starts (initial dysphoric reaction, IDR). The aetiology of reduced subjective well-being or IDR is not fully explained; neuroleptic side effects, especially affective, cognitive and motor adverse events, differential effects of varying psychopathology or biopsychosocial are factors in discussion. The clinical impression is characterised by symptoms as dysphoria/anhedonia, reduced vitality, and emotional indifference, which could have a negative impact on relevant clinical factors such as response or medication adherence, and therefore on outcome. With regard to pharmacological treatment, evidence suggests that atypical antipsychotics induce less negative subjective effects than conventional neuroleptics, and that various new-generation antipsychotics could be evaluated differently by patients. This article reviews existing literature in order to approach relevant questions for pharmacotherapy.

Antipsychotic Agents↗
PubMed2002

Subjective well-being and quality of life under atypical antipsychotic treatment.

The increasing interest in subjective well-being and quality of life of schizophrenic patients represents a conceptual shift in therapeutic outcome criteria. Symptom reduction alone was the most essential outcome parameter for a long time; with the development of atypical antipsychotics more ambitious success criteria, including the patients' perspective, are considered today. While effects on (positive) psychopathology do not differ markedly between typical and atypical antipsychotics, the lack of motor symptoms, the improvement of negative, affective and cognitive symptoms, and particularly the better subjective well-being as well as quality of life are major advantages for the new antipsychotic drugs. Quality of life assessment is a new methodological approach to differentiate therapeutic effects and to give more consideration to the patient's perspective. A number of disease-specific or generic scales have been used to measure quality of life of schizophrenic patients under neuroleptic treatment. There is strong evidence by seven controlled and eight open trials that in comparison to typical neuroleptics, atypicals increase the quality of life significantly, and the difference is of major clinical relevance in many patients. This review describes the development of quality of life research in schizophrenic patients, and summarises the methodological problems and the numerous clinical trials. Furthermore, the benefit of introducing atypical antipsychotics early in the course of illness and their particular benefit in combination with rehabilitative non-pharmacological treatment is discussed.

Antipsychotic Agents↗
PubMed2002

2-COM: an instrument to facilitate patient-professional communication in routine clinical practice.

OBJECTIVE: A simple patient-completed self-report instrument may facilitate patient-professional carer communication. METHOD: A 19-item self-report needs schedule was used in a sample of 243 out-patients with non-affective psychosis. Patients and professional carers commented on the usefulness of the instrument. In a subgroup of 95 patient-carer dyads, the professional carer was asked to rate the needs in addition to the patient. RESULTS: Patients scored their needs reliably and lower than the professionals (OR = 0.9, 95% CI: 0.9, 0.97). Concordance between patients and professional carers on individual needs was very low. More than 50% of the professional carers and more than 80% of the patients found 2-COM useful. The higher the number of needs indicated by the patient, the greater the discrepancy between patients and professional carers with regard to the usefulness of the schedule. CONCLUSION: 2-COM is a useful instrument to expose, and subsequently bridge, patient-professional carer discordance on patient needs.

Adult↗