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Biomedical subjects

Tim Lambert

Publications and source records attributed to Tim Lambert.

8 recordsLinked to original sources
PubMed2006

Selecting patients for long-acting novel antipsychotic therapy.

OBJECTIVE: As new psychopharmacological agents for the management of schizophrenia are introduced into clinical practice, inappropriate patient selection may often lead to disappointing outcomes for the patient, the family and services. Recently, the first and only long-acting novel antipsychotic was made available in Australia. Based on criteria used in a large clinical network in Victoria, this paper sets out to present six selection profiles for patients with schizophrenia who may be suitable candidates for treatment with this class of medication. CONCLUSIONS: Optimizing outcome for patients with enduring psychotic disorders involves enabling a stable psychopharmacological platform upon which to build a psychosocial therapies programme. Too often, problems with adherence undermine the recovery process. Long-acting novel antipsychotics ensure adherence, with all the advantages inherent in second-generation antipsychotics. Identifying patients a priori who might best respond to the long-acting novel antipsychotics may lead to improving the efficiency of the recovery process.

Antipsychotic Agents↗
PubMed2006

A clinical monitoring system for clozapine.

OBJECTIVE: To describe a framework for the initiation and ongoing monitoring of patients on clozapine, and detail support materials that can be used in clinical settings, including general practice, to support this process. CONCLUSIONS: A framework is described. Clozapine has a special place in the management of treatment-resistant schizophrenia. However, it has certain side-effects that require its use to be carefully evaluated on an individual patient basis, and encompass excellent documentation and discussion with all relevant parties. Comprehensive longitudinal monitoring is required.

Antipsychotic Agents↗
PubMed2005

An inter-ethnic comparison study of clozapine dosage, clinical response and plasma levels.

The present study investigated clozapine dosage, plasma clozapine and metabolite levels, clinical and side-effect profiles in Asian versus Caucasian patients with chronic schizophrenia who were on stable maintenance treatment. Twenty Asian patients from Singapore and 20 Caucasian patients from Australia were systematically evaluated with the following rating scales: Positive and Negative Syndrome Scale for Schizophrenia, drug attitude scale (DAI-10), drug adverse reaction profile (Liverpool University Neuroleptic Side-effect Rating Scale), extrapyramidal side-effects scales (Abnormal Involuntary Movement Scale, Simpson and Angus Scale). Cigarette and caffeine consumption were recorded and steady-state plasma clozapine and metabolites levels were measured. Although Asian patients received a significantly lower mean clozapine dose (176 mg/day) than the Caucasian group (433 mg/day, P<0.001), plasma clozapine levels were similar between the groups. As a result, Asian patients had more than twice the effective clozapine concentration to dose ratio (P<0.001). The findings remained significant even after controlling for gender, body mass index, cigarette, alcohol and caffeine use. Conversely, the plasma metabolites (desmethylclozapine and clozapine N-oxide) to clozapine ratios were higher in the Caucasian patients (P<0.01). Compared to Caucasian patients, Asian patients appeared to have a lower dosage requirement for clinical efficacy. Hence, appropriate dose adjustment should be considered in Asian patients receiving maintenance clozapine therapy in clinical practice.

Adult↗
PubMed2004

An audit of outpatient antipsychotic usage in the three health sectors of Auckland, New Zealand.

OBJECTIVE: To examine antipsychotic usage in outpatients in three community mental health centres. METHOD: A retrospective chart review was conducted for all outpatient files that were active in March 2000 at all community mental health services in Auckland (population 1.3 million). All patients prescribed an antipsychotic had information entered into a specifically designed computer software program. The antipsychotic, dose and route of administration were recorded. The diagnosis, number of hospitalizations, ethnicity and gender were also collected. RESULTS: 6558 community files were audited and 3254 people were prescribed antipsychotics; 3178 (97.6%) files had adequate information for study inclusion. The mean antipsychotic daily dose in chlorpromazine equivalents (CPZe) was 360 mg. Most of the population (76.6%) was prescribed an oral antipsychotic alone, 14.9% were prescribed depot antipsychotic only and 8.4% were on a depot and oral antipsychotic. The average daily dose prescribed for people on antipsychotic polypharmacy was 601 mg CPZe compared with 312 mg CPZe for those on a single antipsychotic. There were 2300 patients with schizophrenia (72.5% of cohort) and 585 patients with bipolar affective disorder (18.5%). The mean total daily dose in CPZe was significantly higher for schizophrenia than any other psychotic diagnoses. Regional analysis showed differences in the doses and type of antipsychotics prescribed; one health sector had significantly higher daily doses while another was significantly more likely to prescribe atypical antipsychotics and correspondingly fewer depot antipsychotics. CONCLUSIONS: There is a significant variation in the prescribing of antipsychotics across the three Auckland health sectors. The variation relates to dosage used, type of antipsychotics prescribed and effect of multiple antipsychotic prescribing. Combination therapy of more than one oral antipsychotic or a combination of oral and depot antipsychotics leads to a significant trend of higher doses in excess of best practice guidelines.

Adult↗
PubMed2003

Perception of depot antipsychotics by mental health professionals.

OBJECTIVE: This study examines attitudes of mental health professionals about the use and usefulness of depot antipsychotic medications and determines similarities and differences in attitudes between professional groups. METHODS: Mental health professionals working with patients with severe mental illness completed a questionnaire designed to evaluate their opinions concerning rate of depot use, indications for use of depots, problems with use of depots, common side effects of depots, barriers to switching from depot to oral atypical antipsychotics, impact of staffing levels on drug choice, and relative confidence in various antipsychotics for the management of chronic psychosis. RESULTS: Overall, all professional groups perceived depot antipsychotics as a requirement for the treatment of those with serious mental illness who were poorly adherent. However, there were a number of professional differences in responses to certain items in the survey that probably reflected the degree of direct contact with patients. Medical staff were remarkably uniform in their opinions on the use and usefulness of depots. Mental health staff from all the professional groups surveyed considered extrapyramidal side effects (EPS) a major concern, while few rated cognitive side effects, sexual side effects, and weight gain as significant concerns, even though these problems are reported to be a principal concern of patients. Although all professional groups indicated an awareness of the potential toxicity of depot antipsychotics and there was an overall consensus that atypical antipsychotics are likely to be beneficial in chronic psychosis, limitations in resources were seen as a barrier to switching. CONCLUSIONS: Attitudes concerning the usefulness and rationale for use of depot antipsychotics differ by medical profession. Nursing and allied health workers are more likely than medical staff to note patient specific variables such as weight gain, injection site reactions, and patient preferences as problems with depots. The results also suggest that, in a community-based psychiatric care system, the use of newer and potentially better agents for the management of psychosis is impaired by resource limitations in service delivery as well as by educational disparities between the professions.

Journal Article↗
PubMed2003

Pharmacotherapy of first-episode psychosis.

Early intervention in psychosis has attracted more attention in the last few years. The treatment of this phase of the disorders requires a specific and adapted approach. The issue of engaging the patient is so critical that it influences not only the choice of medication, but also the context and the way in which it is administered. In the case of a first admission, patients should be observed for 24-48 h without any antipsychotic treatment, in order to clarify the diagnosis and exclude the possibility that symptoms are caused by acute intoxication with illicit substances, for example. The diagnosis is often difficult and unstable. A dimensional, rather than a categorical approach, is usually more likely to be adopted. In recent years, atypical antipsychotics have become the most frequently used first-line treatment. They are less likely to cause secondary negative symptoms, cognitive impairments and dysphoria. They also appear to influence the course of depression and hostility/aggression better than conventional neuroleptics, have possibly mood-stabilising properties and, subjectively, are often better accepted by patients. On the risk side, prevalence of acute extrapyramidal side effects and possibly tardive dyskinesia are lower, compared to the older neuroleptics. Although, the risk for short-term weight gain, cardiovascular, and especially hyperglycaemic complications are somewhat higher for some of these antipsychotics. Finally, the dose should be adapted as it has been shown that patients presenting a first psychotic episode respond to a lower dose of antipsychotic. This article focuses on the pharmacotherapy of first-episode psychosis, on the basis of a computerised and a manual search for articles dealing with antipsychotic treatment of these patients. Findings are discussed and combined in clinical guidelines for first-episode affective and non-affective psychosis, for patients with incomplete recovery or treatment resistance, for cases of emergency and for side effects associated with antipsychotic treatment.

Antipsychotic Agents↗