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Johannes Hamann

Publications and source records attributed to Johannes Hamann.

14 recordsLinked to original sources
PubMed2005

How do psychiatrists choose among different antipsychotics?

OBJECTIVE: We attempted to determine the decision rules psychiatrists use in the choice of antipsychotic drugs for inpatients with schizophrenia. METHODS: Interviews were conducted with 50 hospital psychiatrists in Southern Germany. Each physician was interviewed with respect to the reasons for his antipsychotic drug choice in the cases of three patients with a diagnosis of schizophrenia. Interviews were audiotaped and subsequently analyzed using a standardized coding scheme. RESULTS: The clinical decision rules identified are highly complex, with a mean of eight categories cited per patient. Categories named included the patient's past treatment response, side effects, intended route of administration and co-morbidities. Moreover, psychiatrists strongly take the patient's target symptoms and the assumed efficacy of certain compounds into account in their choice of medication. CONCLUSION: Psychiatrists' explanations for their antipsychotic drug choice seem for the most part reasonable and overlap substantially with drug-choice algorithms of clinical guidelines. However, psychiatrists additionally use indicators that--in their view--might predict treatment response. For these indicators, which are derived from personal experience, it is still unclear whether they are valid and simply have not yet been proven in clinical trials or whether they merely represent unfounded assumptions on the part of the doctors.

Adult↗
PubMed2005

What does the PANSS mean?

OBJECTIVE: Despite the frequent use of the Positive and Negative Syndrome Scale (PANSS) for rating the symptoms of schizophrenia, the clinical meaning of its total score and of the cut-offs that are used to define treatment response (e.g. at least 20% or 50% reduction of the baseline score) are as yet unclear. We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions (CGI). METHOD: PANSS and CGI ratings at baseline (n = 4091), and after one, two, four and six weeks of treatment taken from a pooled database of seven pivotal, multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking. RESULTS: Being considered "mildly ill" according to the CGI approximately corresponded to a PANSS total score of 58, "moderately ill" to a PANSS of 75, "markedly ill" to a PANSS of 95 and severely ill to a PANSS of 116. To be "minimally improved" according to the CGI score was associated with a mean percentage PANSS reduction of 19%, 23%, 26% and 28% at weeks 1, 2, 4 and 6, respectively. The corresponding figures for a CGI rating "much improved" were 40%, 45%, 51% and 53%. CONCLUSIONS: The results provide a better framework for understanding the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations. Such studies may ideally use at least a 50% reduction from baseline cut-off to define response rather than lower thresholds. In treatment resistant populations, however, even a small improvement can be important, so that a 25% cut-off might be appropriate.

Adult↗
PubMed2005

Early-onset hypothesis of antipsychotic drug action: a hypothesis tested, confirmed and extended.

BACKGROUND: A recent meta-analysis rejected the "delayed onset of antipsychotic action hypothesis" that had been described in textbooks for decades. Since meta-analyses are prone to a number of methodological problems, we attempted a replication by a) using a large database of individual patient data rather than meta-analysis, b) including another antipsychotic and c) extending the analysis from four weeks to one year. METHODS: We pooled the data of seven randomized trials involving amisulpride. The data included 1708 patients with schizophrenia and positive symptoms and we examined the incremental percentage Brief Psychiatric Rating Scale (BPRS) reduction over time. RESULTS: The "early onset of antipsychotic action hypothesis" was confirmed, as the reduction of overall and positive symptoms until week two was larger than the additional reduction until week four (p<.0001). Furthermore, in a subset with long-term data (n=748) approximately 68% of the mean BPRS change at one year was already achieved at four weeks in the observed cases. CONCLUSIONS: A substantial amount of the antipsychotic drug effect seems to occur during the first weeks of treatment. Subsequent analyses are needed to establish how long an antipsychotic should be tried before it is considered ineffective and alternative strategies implemented.

Amisulpride↗
PubMed2005

Postoperative acute confusional state in typical urologic population: incidence, risk factors, and strategies for prevention.

OBJECTIVES: To determine the incidence of, and predictors for, the acute confusional state (ACS) in older patients after urologic surgery. ACS is among the most common complications after surgery in older patients. It is associated with increased postoperative morbidity, longer hospital stays, and greater mortality. Agitation caused by ACS might have deleterious consequences in a large proportion of older patients, especially after urologic surgery. Only a few studies, of highly selected urologic procedures, have been reported, and all showed an astonishingly low percentage of patients with this distressing condition. METHODS: We examined 100 consecutive, older patients (age 60 years or older), prospectively, before and after urologic surgery, to determine both the incidence of, and the predictors for, ACS. RESULTS: Only 7 of the 100 patients developed postoperative ACS. The risk factors identified were preoperative cognitive deficits, pre-existing depression, impaired vision, and the operative time. CONCLUSIONS: These results suggest that postoperative ACS is relatively rare after urologic surgical procedures; however, patients who are likely to develop ACS can be identified, prompting consideration for prophylactic antidelirium care.

Acute Disease↗
PubMed2005

Do patients with schizophrenia wish to be involved in decisions about their medical treatment?

OBJECTIVE: Little is known about the desire of patients with schizophrenia to be involved in medical decisions affecting their treatment. METHOD: The authors administered the Autonomy Preference Index to 122 inpatients with schizophrenia. In addition, the patients filled out the Drug Attitude Inventory. Sociodemographic data and Positive and Negative Syndrome Scale ratings were available for all patients. RESULTS: The patients expressed a desire for shared decision making that was slightly greater than that of primary care patients. Negative attitudes toward medical treatment and younger age were associated with a higher desire for participation. CONCLUSIONS: It is important to meet the participation needs of patients who are dissatisfied with their psychiatric treatment.

Adult↗
PubMed2005

Physicians' and patients' involvement in relapse prevention with antipsychotics in schizophrenia.

The purpose of this study was to assess the current status of relapse prevention in schizophrenia. Fifty hospital psychiatrists in Germany were interviewed about 100 currently treated inpatients. The patients were also interviewed about their knowledge of maintenance therapy. For 75 percent of their patients, physicians fulfilled guideline recommendations when indicating the planned duration of antipsychotic maintenance therapy. However, these recommendations were not routinely communicated to the patients, and target interventions, such as psychoeducation, to guarantee continuous antipsychotic therapy were seldom used. Accordingly, patients' knowledge of the optimal duration of maintenance therapy was poor.

Adult↗
PubMed2005

Clinical implications of Brief Psychiatric Rating Scale scores.

BACKGROUND: Despite the widespread use of the Brief Psychiatric Rating Scale (BPRS), the clinical meaning of its total score and cut-off values used to define treatment response are unclear. AIMS: To link the BPRS to Clinical Global Impression (CGI) ratings. METHOD: Equipercentile linking of BPRS and CGI ratings from seven drug trials in acutely ill patients with schizophrenia (n=1979). RESULTS: 'Mildly ill' according to the CGI approximately corresponded to a BPRS total score of 31, 'moderately ill'to a BPRS score of 41 and'markedly ill'to a BPRS score of 53.'Minimally improved'according to the CGI score was associated with percentage BPRS reductions of 24, 27 and 30% at weeks 1, 2 and 4, respectively. The corresponding numbers for a CGI rating of 'much improved' were 44, 53 and 58%. CONCLUSIONS: The results provide a clearer understanding of how to interpret BPRS total and percentage reduction scores in clinical trials with patients acutely ill with schizophrenia who are experiencing positive symptoms.

Acute Disease↗
PubMed2004

Medical decision making in antipsychotic drug choice for schizophrenia.

OBJECTIVE: The influence of patient and physician variables on antipsychotic drug choice for patients with schizophrenia was assessed. METHOD: Interviews with 100 psychiatrists on drug choice for 200 patients suffering from schizophrenia were conducted. Data were analyzed by using multiple logistic regression. RESULTS: Older physicians were up to five times more likely to prescribe first-generation antipsychotics. Patient variables did not influence treatment decisions significantly. CONCLUSIONS: There is an urgent need for more research on clinical decision making and quality management.

Adult↗
PubMed2004

[Shared decision making--from a model project towards implementation].

The model study "Shared Decision Making in the Treatment of Schizophrenia" has indicated both the positive prospects of increased patient involvement in treatment decisions and the potential barriers to subsequent implementation of this model in routine care. Thus an expert panel consisting of patients and professionals within the scope of the research program "Der Patient als Partner im medizinischen Entscheidungsprozess" [The Patient as a Partner in Clinical Decision Making] sponsored by the German Ministry of Health concluded that approaches to changing the physicians' behaviour alone will be insufficient to implement shared decision making. Rather, there is an urgent need to encourage and empower patients to claim their rights to information and participation.

Germany↗
PubMed2003

Amisulpride is an "atypical" antipsychotic associated with low weight gain.

RATIONALE: It is possible that amisulpride, with its unique receptor binding profile, is not associated with significant weight gain, a serious side effect of most "atypical" antipsychotic drugs. While most "atypicals" have a high affinity for both dopamine and serotonin receptors, amisulpride has only dopamine receptor action. OBJECTIVES: To analyse the weight gain associated with amisulpride. METHODS: A pooled database of prospective randomised amisulpride studies was analysed. The mean weight gain after 10 weeks of treatment was estimated by regression analysis. RESULTS: Eleven studies with a total of 1422 patients were pooled, providing 1392 patients who were eligible for evaluation. In the main analysis of all effective doses (50-1200 mg/day) the mean weight gain associated with amisulpride at 10 weeks was 0.8 kg, 95% CI (0.48-1.18). Linear regression showed no dependence of weight gain on daily dose levels (P=0.7). When patients with mean daily doses below 400 mg/day were excluded in a sensitivity analysis, the mean weight gain at ten weeks was again 0.80 kg, 95% CI (0.47-1.16) with n=874. The mean weight gain at study endpoints in 1-year studies was 1.4 kg, 95% CI (0.85-1.90), n=548. CONCLUSION: Amisulpride is an atypical antipsychotic associated with low weight gain.

Amisulpride↗
PubMed2003

New generation antipsychotics versus low-potency conventional antipsychotics: a systematic review and meta-analysis.

BACKGROUND: The clearest advantage of new generation, atypical antipsychotics is a reduced risk of extrapyramidal side-effects (EPS), compared with conventional compounds. These findings might have been biased by the use of the high-potency antipsychotic haloperidol as a comparator in most of the trials. We aimed to establish whether the new drugs induce fewer EPS than low-potency conventional antipsychotics. METHODS: We did a meta-analysis of all randomised controlled trials in which new generation antipsychotics had been compared with low-potency (equivalent or less potent than chlorpromazine) conventional drugs. We included studies that met quality criteria A or B in the Cochrane Collaboration Handbook, and assessed quality with the Jadad scale. The primary outcome of interest was the number of patients who had at least one EPS. We used risk differences and 95% CIs as measures of effect size. FINDINGS: We identified 31 studies with a total of 2320 participants. Of the new generation drugs, only clozapine was associated with significantly fewer EPS (RD=-0.15, 95% CI -0.26 to -0.4, p=0.008) and higher efficacy than low-potency conventional drugs. Reduced frequency of EPS seen with olanzapine was of borderline significance (-0.15, -0.31 to -0.01, p=0.07). Only one inconclusive trial of amisulpride, quetiapine, and risperidone and no investigations of ziprasidone and sertindole were identified, but some evidence indicates that zotepine and remoxipride do not lead to fewer EPS than low-potency antipsychotics. Mean doses less than 600 mg/day of chlorpromazine or its equivalent had no higher risk of EPS than new generation drugs. As a group, new generation drugs were moderately more efficacious than low-potency antipsychotics, largely irrespective of the comparator doses used. INTERPRETATION: Optimum doses of low-potency conventional antipsychotics might not induce more EPS than new generation drugs. Potential advantages in efficacy of the new generation drugs should be a factor in clinical treatment decisions to use these rather than conventional drugs.

Antipsychotic Agents↗
PubMed2003

Antipsychotic prescribing patterns in Germany: a retrospective analysis using a large outpatient prescription database.

Data of prescribing practices for antipsychotics are of great interest with respect to quality of care. Consequently, we analysed all prescriptions under the statutory health insurance redeemed at pharmacies in Southern Germany between July 1999 and December 2001. The database covers prescriptions for approximately 25 million people. Up to 6% of the population were prescribed an antipsychotic at least once during the study period. Most prescriptions were for conventional antipsychotics and written by non-specialists. Patients receiving second generation antipsychotics were more likely to receive continuous antipsychotic therapy. For a large proportion of patients, antipsychotic polypharmacy, as well as comedication for somatic illnesses, were observed. In particular, drugs for the treatment of cardiovascular and metabolic disorders were frequently co-prescribed. Physicians should consider patients' cardiovascular and metabolic risk profile when making treatment choices. The data suggest that the majority of antipsychotics are used for the treatment of disorders other than schizophrenia. It is important to raise awareness among non-specialists about the indications, efficacy and side-effects of the antipsychotics because these physicians account for the majority of antipsychotic prescriptions.

Adolescent↗