Are we still talking to our patients with schizophrenia?
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Antipsychotic Agents↗
Biomedical subjects
Samuel J Keith
Publications and source records attributed to Samuel J Keith.
Practical application of pharmacotherapy with long-acting risperidone for patients with schizophrenia.
OBJECTIVE: It is now generally accepted that the use of second-generation, or atypical, antipsychotics for schizophrenia represents an advance over conventional antipsychotic agents. However, adherence continues to be a problem, as with other medications for chronic disorders. Long-acting formulations of conventional antipsychotics partly address adherence problems, but their use is limited by tolerability issues. This article provides practical advice to physicians on the characteristics of patients who would benefit from treatment with long-acting atypical antipsychotic agents and offers suggestions on how to initiate treatment. METHODS: A literature search for studies published between 1980 and 2003 that evaluated the treatment of patients with schizophrenia with long-acting atypical agents was conducted by using MEDLINE and EMBASE. The primary search parameters were "schizophrenia," "atypical," "antipsychotic," and "long-acting." As expected, long-acting risperidone was the only long-acting atypical agent identified; thus this article focuses on practical advice and suggestions on how to initiate therapy with long-acting risperidone. RESULTS AND DISCUSSION: From the results of the literature search and the discussion of a panel of experts at a meeting held in Dublin in 2003 and supported by Johnson & Johnson, it is possible to conclude that long-acting risperidone has demonstrated efficacy and tolerability, even among patients who are considered clinically stable on other antipsychotics. Most patients can switch safely and effectively to long-acting risperidone if appropriate strategies are applied. Long-acting risperidone provides a new and promising therapeutic option for the treatment of schizophrenia.
Antipsychotic Agents↗
Academic highlights: guidelines for the use of long-acting injectable atypical antipsychotics.
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Antipsychotic Agents↗
Long-acting injectable risperidone: efficacy and safety of the first long-acting atypical antipsychotic.
OBJECTIVE: The authors assessed the efficacy and safety of the first long-acting atypical antipsychotic (long-acting injectable risperidone) in patients with schizophrenia. METHOD: In a 12-week, multicenter, double-blind, randomized study, patients received intramuscular injections every 2 weeks of placebo or long-acting risperidone (25 mg, 50 mg, or 75 mg). The primary measure of efficacy was the change in total score on the Positive and Negative Syndrome Scale. RESULTS: Of the 554 patients who were enrolled, 400 entered the double-blind study, and 370 received at least one postbaseline assessment. Mean changes in score of -6.2, -8.5, and -7.4 on the Positive and Negative Syndrome Scale were seen at endpoint for the 25-, 50-, and 75-mg risperidone groups, respectively; all three change scores were significantly different from that seen with placebo (+2.6). Improvements in positive and negative symptoms were also significantly greater in patients receiving risperidone. Long-acting risperidone was well tolerated. Adverse events related to extrapyramidal symptoms were spontaneously reported by 13% of patients receiving placebo and 10% of patients in the 25-mg risperidone group, with higher rates in the 50-mg and 75-mg groups. Severity of extrapyramidal symptoms was mild at baseline and throughout the trial in each treatment group. Mean weight changes were small in the 25-, 50-, and 75-mg risperidone groups (0.5 kg, 1.2 kg, and 1.9 kg, respectively). Injection site pain was rated as low by the patients, consistent with the investigators' pain ratings. CONCLUSIONS: Long-acting injectable risperidone was efficacious and well tolerated and provides both clinicians and patients with a new mode of treatment that can improve the outcome of long-term therapy.
Adolescent↗
Integrated treatment of schizophrenia.
The importance of combining psychosocial and pharmacologic interventions for optimum outcome in the treatment of schizophrenia is now well recognized. However, less research is available on ways in which the two types of treatment may affect each other. This article reviews research and principles applying to the integrated use of current psychosocial and pharmacologic treatments for schizophrenia. Emphasis is placed on areas of interaction, including patient adherence and the effect of antipsychotic medications on cognitive functioning. Recommendations are presented for specific clinical situations.
Clinical Trials as Topic↗
Partial compliance and patient consequences in schizophrenia: our patients can do better.
OBJECTIVE: The primary objective of this review is to evaluate the strategies used to improve patient compliance with antipsychotic medication in the treatment of schizophrenia. DATA SOURCES: An electronic literature search of relevant studies using MEDLINE and the Cochrane Library (January 1974-December 2002) was performed using the search terms adherence, antipsychotic, atypical, compliance, conventional, and schizophrenia. STUDY SELECTION: English-language and non-English-language articles, references from bibliographies of reviews, original research articles, and other articles of interest were reviewed. DATA EXTRACTION: Data quality was determined by publication in the peer-reviewed literature and the most important information was identified. DATA SYNTHESIS: Atypical antipsychotics are associated with an improved side-effect profile and reduced risk of relapse compared with the older agents. Additional benefit may be provided by long-acting injectable formulations as they provide the confidence of continuous medication coverage. CONCLUSIONS: Successful treatment of patients with schizophrenia requires acknowledgment that partial compliance will present a major barrier to achieving maximum outcomes. Ideally, all patients suspected of partial compliance should be considered suitable for treatment with a long-acting injectable atypical antipsychotic.
Antipsychotic Agents↗