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Biomedical subjects

G J Remington

Publications and source records attributed to G J Remington.

At least 19 recordsLinked to original sources
PubMed1998

The Canadian experience with risperidone for the treatment of schizophrenia: an overview.

OBJECTIVE: To summarize published data to date by Canadian authors and from Canadian sources on risperidone, a novel neuroleptic indicated in the management of schizophrenia and related psychotic disorders. It was introduced in Canada in 1993. DATA SOURCES: A MEDLINE search was performed using "risperidone" as a keyword. Three Canadian journals were also searched manually. STUDY SELECTION: Articles published between January 1991 and June 1996 by Canadian authors or involving Canadian patients. DATA EXTRACTION: Retrieved articles were categorized according to data on efficacy, safety, resource use/economics and other miscellaneous aspects. Articles were abstracted and summarized. Some non-Canadian sources were used for comparison. DATA SYNTHESIS: The initial Canadian multicentre trial found resperidone (6 mg daily) to be superior to haloperidol (20 mg daily) in reducing positive and negative symptoms, with fewer extrapyramidal side effects (EPS). Various case reports have extended both the clinical use and safety profile of risperidone, while neuro-imaging studies have tried to clarify its mechanism of action. Economic studies suggest substantial cost benefits due to prevention of hospitalization as well as improvement in quality of life. CONCLUSIONS: Canadian research has contributed considerably to the current knowledge regarding risperidone. Future studies, both controlled and naturalistic, will need to focus on comparisons with the various new compounds now available.

Antipsychotic Agents↗
PubMed1997

Insight, neurocognitive function and symptom clusters in chronic schizophrenia.

Only recently has there been interest in the systematic study of insight in schizophrenia. The present investigation was designed to evaluate the specific relationship between psychopathological symptoms, neurocognitive deficits and awareness of illness in chronic schizophrenia. Fifty-eight outpatients with the DSM-III-R diagnosis of schizophrenia were rated on David's Schedule for Assessing Insight, the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale and the Wisconsin Card Sorting Test (WCST). Results indicate that there is a significant association among these variables and that approximately 44% of the variance in the dependent variable could be explained by this combination of independent variables. Notably, however, negative symptoms were only moderately inversely correlated with awareness of illness, and they were not associated with scores on the WCST. Moreover, neither negative symptoms nor per cent perseverative errors contributed significantly to the prediction of insight in schizophrenia. These findings argue against the notion that unawareness of illness is the product of neuropsychological dysfunction in the frontal lobes. Instead, the most significant associations and predictors of insight were related to the positive symptoms of schizophrenia.

Adaptation, Psychological↗
PubMed1997

Neuroleptic dosing in chronic schizophrenia: a 10-year follow-up.

OBJECTIVE: To evaluate neuroleptic dosing patterns in individuals with schizophrenia over a 10-year interval. METHOD: Changes in neuroleptic dosing between 1980 and 1990 were followed in 65 patients with a diagnosis of chronic schizophrenia. RESULTS: According to more recent dosing guidelines, doses were already high at the time of initial evaluation, yet overall they continued to increase during the next decade of treatment for both males and females. Patients were almost equally divided, however, by those who underwent an increase (n = 33) and those whose dose remained stable (n = 4) or was decreased (n = 28). CONCLUSION: A considerable number of patients with schizophrenia appear to receive progressively higher neuroleptic doses over the course of their illness, despite a lack of empirical data to support such an approach. Results are discussed in terms of current dosing recommendations and factors influencing dose changes.

Adult↗
PubMed1996

The D2 receptor occupancy profile of loxapine determined using PET.

Positron emission tomography (PET) studies of typical neuroleptics suggest that 60% to 80% of striatal D2 occupancy may be sufficient for optimal clinical treatment of psychosis. Therefore, striatal D2 occupancy may be used as an index to determine the optimal dose range. Toward this end, we determined the in vivo D2 profile of loxapine, using [11C]-raclopride and PET. Seven patients selected from a clinical population were scanned while taking steady-state oral loxapine from 10 to 100 mg/day. Their D2 receptor occupancy was estimated by comparing them to age-matched data from neuroleptic-naive patients. The D2 receptor occupancy ranged from 52% to 90%, and there was a very strong relationship between dose and D2 occupancy, suggesting that 15 to 30 mg/day of loxapine would produce, the putatively optimal, 60% to 80% striatal D2 blockade. This dose range is much lower than that used in most clinical settings and points to the potential efficacy of loxapine at lower doses.

Administration, Oral↗
PubMed1996

Clozapine: current status and role in the pharmacotherapy of schizophrenia.

OBJECTIVE: This study evaluates clozapine and its present role in the pharmacotherapy of schizophrenia. METHOD: Clozapine's current clinical status is reviewed, as is its position with respect to other treatment options. RESULTS: Clozapine represents the prototype of "atypical" neuroleptics, with evidence of clinical efficacy in both positive and negative symptoms, as well as a diminished risk of extrapyramidal side effects. It is the only neuroleptic to date that has established itself as having little, if any, risk of tardive dyskinesia. More recent research has focused on its potential for overall savings in health care costs, as well as possible benefits in the area of neuropsychological functioning. CONCLUSION: Evidence suggesting that the course of schizophrenia can be altered by effective treatment favours a systematic approach that optimizes treatment options. While clozapine does not represent a 1st-line agent because of its risk of agranulocytosis, it has an integral role to play in treatment-resistant schizophrenia or in individuals experiencing intolerable side effects with conventional neuroleptics.

Agranulocytosis↗
PubMed1995

Depot neuroleptic therapy: clinical considerations.

The management of schizophrenia is generally a long-term process with neuroleptics representing the cornerstone of treatment. Although not without their own limitations, depot neuroleptics offer an important alternative to oral agents, and they should be routinely considered as an option in any long-term treatment planning. The present article reviews depot neuroleptics, and focuses particularly on clinical considerations pertaining to their use.

Antipsychotic Agents↗
PubMed1994

Antiparkinsonian drugs in the treatment of neuroleptic-induced extrapyramidal symptoms.

Most patients on neuroleptic therapy experience extrapyramidal symptoms in one form or another during treatment. While the risk of extrapyramidal symptoms appears diminished with the newer and "atypical" neuroleptics (for example, risperidone, remoxipride, clozapine), it is not eliminated. It is essential that the treating clinician monitor for such side effects since if they are left untreated they can be an ongoing source of discomfort to the patient and may affect compliance with therapy. Antiparkinsonian medication represents the mainstay of treatment for neuroleptic-induced extrapyramidal symptoms. Their clinical use is reviewed here with reference to mode of action, indications, choice, side-effects and precautions.

Antiparkinson Agents↗
PubMed1994

Erotomanic delusions and electroconvulsive therapy: a case series.

BACKGROUND: Erotomania, as a primary disorder, is categorized in DSM-III-R under delusional (paranoid) disorder. However, erotomanic delusions also are seen frequently in the context of other psychiatric disorders. There is increasing evidence that patients with such delusions often have an underlying affective disorder and effective treatment of the underlying disorder can lead to resolution of the erotomanic delusions. METHOD: The case histories of three patients with prominent affective features and erotomanic delusions are presented. RESULTS: Each patient was treated with bilateral electroconvulsive therapy (ECT) after experiencing treatment failure with numerous other somatic therapies. One showed only a slight and transient improvement, while two demonstrated resolution of the erotomanic delusions. CONCLUSION: Bipolar and schizoaffective disorder should be considered in patients with erotomanic delusions, and ECT may offer an effective alternative when other somatic treatments have failed.

Adult↗
PubMed1993

Dosaging patterns in schizophrenia with depot, oral and combined neuroleptic therapy.

A group of patients with chronic schizophrenia were evaluated according to the form of neuroleptic treatment they were receiving: depot, oral or combined (depot/oral or oral/oral). The patients treated with the combined therapy received significantly higher dosages of neuroleptic than those treated with either depot or oral therapy, which did not differ from each other. Daily maintenance dosages were generally well above recent guidelines.

Administration, Oral↗
PubMed1993

Clinical considerations in the use of risperidone.

Clinical studies to date have shown that risperidone is an effective antipsychotic agent in the treatment of both positive and negative symptomatologies, with a side-effect profile that is superior to standard neuroleptics. It may represent a potentially useful first-line agent in the treatment of schizophrenia, and clinicians may consider switching to risperidone if current neuroleptic therapy yields poor control of symptoms or problematic side-effects, such as extrapyramidal symptoms or tardive dyskinesia. This article discusses the relevant clinical considerations in switching neuroleptics and proposes practical guidelines on issues such as dosing and course of therapy with risperidone.

Clinical Trials as Topic↗
PubMed1990

Prevalence of neuroleptic-induced dystonia in mania and schizophrenia.

In a prospective study of 41 acutely psychotic patients, neuroleptic-induced dystonic reactions occurred in 62.5% of the manic patients (10 of 16) and 66.7% of the schizophrenic patients (10 of 15), a nonsignificant difference. These findings contradict a recent report suggesting a higher risk for this side effect in mania.

Acute Disease↗