Biomedical subjects

John A Chiles

Publications and source records attributed to John A Chiles.

3 recordsLinked to original sources

PubMed2004

The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update.

BACKGROUND: The Texas Medication Algorithm Project (TMAP) has been a public-academic collaboration in which guidelines for medication treatment of schizophrenia, bipolar disorder, and major depressive disorder were used in selected public outpatient clinics in Texas. Subsequently, these algorithms were implemented throughout Texas and are being used in other states. Guidelines require updating when significant new evidence emerges; the antipsychotic algorithm for schizophrenia was last updated in 1999. This article reports the recommendations developed in 2002 and 2003 by a group of experts, clinicians, and administrators. METHOD: A conference in January 2002 began the update process. Before the conference, experts in the pharmacologic treatment of schizophrenia, clinicians, and administrators reviewed literature topics and prepared presentations. Topics included ziprasidone's inclusion in the algorithm, the number of antipsychotics tried before clozapine, and the role of first generation antipsychotics. Data were rated according to Agency for Healthcare Research and Quality criteria. After discussing the presentations, conference attendees arrived at consensus recommendations. Consideration of aripiprazole's inclusion was subsequently handled by electronic communications. RESULTS: The antipsychotic algorithm for schizophrenia was updated to include ziprasidone and aripiprazole among the first-line agents. Relative to the prior algorithm, the number of stages before clozapine was reduced. First generation antipsychotics were included but not as first-line choices. For patients refusing or not responding to clozapine and clozapine augmentation, preference was given to trying monotherapy with another antipsychotic before resorting to antipsychotic combinations. CONCLUSION: Consensus on algorithm revisions was achieved, but only further well-controlled research will answer many key questions about sequence and type of medication treatments of schizophrenia.

Algorithms↗

PubMed2002

Itemized clinician ratings versus global ratings of symptom severity in patients with schizophrenia.

This study compares ratings obtained with an itemized clinician-rated symptom severity measure--the 24-item Brief Psychiatric Rating Scale (BPRS24)--with a Physician Global Rating Scale (PhGRS) and a Patient Global Rating Scale (PtGRS) in assessing treatment outcomes in patients with schizophrenia (SCZ). A total of 91 patients (31 inpatients and 60 outpatients) with SCZ were enrolled in a feasibility study of the use of medication algorithms in the treatment of SCZ. Clinicians completed the BPRS24 and the PhGRS; patients completed the PtGRS at each visit. The analyses reported here were conducted using the original BPRS18 and four items from the BPRS18 that rate the positive symptoms of psychosis (the Positive Symptom Rating Scale or PSRS), comparing anchored with global rating scales and with one another. The PtGRS had the lowest effect size (0.8) and was negatively correlated with the other ratings in inpatients. The PhGRS was significantly correlated (0.46) with the BPRS18, but the same person completed both ratings. The effect size of the PhGRS (0.6) was generally lower than with the BPRS18 (1.4) in differentiating responders from non-responders. On average, the PSRS had a slightly lower effect size than the longer itemized BPRS18, but the results support its use as a quantitative rating in circumstances where it is not feasible to routinely use a lengthier scale.

Adolescent↗

PubMed2002

Multicenter trial of fluoxetine as an adjunct to behavioral smoking cessation treatment.

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-behavioral therapy, and biologically verified 7-day self-reported abstinence follow-ups were conducted at 1, 3, and 6 months posttreatment. Analyses assuming missing data counted as smoking observed no treatment difference in outcomes. Pattern-mixture analysis that estimates treatment effects in the presence of missing data observed enhanced quit rates associated with both the 60-mg and 30-mg doses. Results support a modest, short-term effect of fluoxetine on smoking cessation and consideration of alternative models for handling missing data.

Adult↗