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Find video protocols related to scientific articles indexed in Pubmed.
Switching to Iloperidone.
Clin Schizophr Relat Psychoses
PUBLISHED: 11-05-2014
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Objective: To describe secondary analyses from a 12-week, randomized, open-label trial where adult schizophrenia outpatients receiving risperidone, olanzapine, or aripiprazole were switched to iloperidone. Methods: Patients switched to iloperidone were randomized into 2 groups - one group where the dose of the antecedent antipsychotic was titrated downwards and discontinued by 2 weeks, and the other group where the antecedent antipsychotic was abruptly stopped. A total of 500 patients were randomized and received open-label iloperidone (gradual switch, n=240; immediate switch, n=260), with 175, 155, and 170 patients switched from risperidone, olanzapine, and aripiprazole, respectively. All patients were titrated on iloperidone to an initial target dose of 12 mg/day (6 mg twice a day) by Day 4 after which iloperidone could be flexibly dosed between 12 to 24 mg/day (6 to 12 mg twice a day), as per clinical judgment (median dose at study end was 16 mg/day). Adaptations of the Clinical Global Impression-Severity (CGI-S) scale were used to evaluate clinical changes that occurred from baseline over 12 weeks of treatment, providing data on efficacy (E-CGI-S) and safety (ST-CGI-S), as well as on an integrated measure of severity (I-CGI-S) and change (I-CGI-C). Other assessments included the reporting of adverse events (AEs), study discontinuation, body weight, and metabolic variables. Results:Improvement was steady throughout the study for both gradual- and immediate-switch groups starting at Week 1 and continuing through Week 12. Discontinuations due to AEs in the first 2 weeks of treatment were higher for the immediate-switch group compared with the gradual-switch group (10.8% vs. 5.4%, NNT 19, 95% CI 10-151). Fewer patients in the gradual- switch group experienced dizziness as an AE, whereas a higher percentage of patients in the immediate-switch group exhibited earlier onset of a therapeutic response within the first 2 weeks; both groups were comparable thereafter with low rates of dizziness and similar efficacy outcomes. Conclusions: Switching to iloperidone can be accomplished either with a gradual crossover or immediate discontinuation of the prior antipsychotic; however, the immediate-switch method is associated with greater proportion of initial dizziness. The observed outcomes are consistent with what has been previously reported regarding iloperidone's favorable akathisia/EPS profile and modest impact on somnolence/sedation, body weight, and metabolic variables..
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Disease and drug effects on internally-generated and externally-elicited responses in first episode schizophrenia and psychotic bipolar disorder.
Schizophr. Res.
PUBLISHED: 08-08-2014
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Neurocognitive deficits are associated with most psychotic disorders, but may differ across diagnosis and by treatment status. This ambiguity is partly addressed in longitudinal pre/post treatment studies with first episode patients. Antipsychotic-naïve first-episode schizophrenia patients have shown intact performance on a predictive saccade task that assesses simple motor learning, spatial abilities, and response planning. After antipsychotic treatment, however, schizophrenia patients performing this task show a selective impairment in the accuracy of anticipatory responses, generated from learned internal representations of the task stimulus. This finding is in line with other observations of antipsychotic medication effects on frontostriatal systems, particularly dorsolateral prefrontal cortex. We sought to replicate this provocative finding with an independent sample of antipsychotic-naïve first-episode schizophrenia patients and extend it by including a group of patients with first episode bipolar disorder with psychosis (BDP). Matched healthy controls were also studied in parallel. Schizophrenia patients demonstrated intact performance pretreatment followed by impairment post-treatment for accuracy of anticipatory responses, and worse accuracy was associated with higher antipsychotic dose. BDP patients displayed saccade accuracy deficits before and after treatment and had no correlation of performance and antipsychotic dose. The findings suggest different neural alterations early in the course of each psychotic disorder, and different vulnerabilities to antipsychotic treatment effects between schizophrenia and BDP.
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Impact of Antipsychotic Treatment on Attention and Motor Learning Systems in First-Episode Schizophrenia.
Schizophr Bull
PUBLISHED: 06-05-2014
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Antipsychotic medications have established clinical benefit, but there are few neuroimaging studies before and after initiating antipsychotic medication to assess drug influence on brain circuitry. Attention and motor learning tasks are promising approaches for examining treatment-related changes in frontostriatal systems.
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Comparison of olanzapine long-acting injection and oral olanzapine: a 2-year, randomized, open-label study in outpatients with schizophrenia.
J Clin Psychopharmacol
PUBLISHED: 05-01-2014
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We compared long-term treatment effectiveness of monthly olanzapine long-acting injection (LAI) with that of oral olanzapine. Outpatients with 2 or more episodes of psychotic worsening in the past 24 months with Positive and Negative Syndrome Scale total score of lower than 70 were randomized to 405 mg/4 weeks of olanzapine LAI (n = 264) or 10 mg/d of oral olanzapine (n = 260) for 2 years of open-label treatment. Dosing thereafter was flexible (150-405 mg/4 weeks of LAI vs 5-20 mg/d of oral). Primary outcome was time to all-cause discontinuation. At baseline, patients were clinically stable (mean Positive and Negative Syndrome Scale total score of 57). Seventeen percent of patients had been psychiatrically hospitalized in the previous 6 months, and 4.6% were rated nonadherent in the month before study entry. The groups did not differ significantly in median time to all-cause discontinuation (645 days for LAI, 678 days for oral; P = 0.61), discontinuation rate (53.8% for LAI, 51.2% for oral; P = 0.60), or relapse rate (20.1% for LAI, 18.5% for oral; P = 0.66). Postbaseline psychiatric hospitalization rate was low for both groups (7.6% for LAI, 9.2% for oral), but mean hospitalization duration was significantly longer for oral patients (1.80 days [20 for those hospitalized] vs 0.43 days [6 for those hospitalized], P = 0.02). There were no clinically significant group differences in adverse events or safety measures. No post-injection delirium/sedation syndrome events occurred. In conclusion, olanzapine LAI and oral olanzapine were similarly effective and well tolerated for up to 2 years of treatment in patients with schizophrenia. Treatment discontinuation for olanzapine LAI was similar to that of oral olanzapine, despite the 3-hour post-injection observation period and other precautionary procedures related to risk of post-injection delirium/sedation syndrome.
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A trial evaluating gradual- or immediate-switch strategies from risperidone, olanzapine, or aripiprazole to iloperidone in patients with schizophrenia.
Schizophr. Res.
PUBLISHED: 02-12-2014
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In a 12-week randomized open-label trial, adults diagnosed with schizophrenia experiencing inadequate efficacy and/or poor tolerability on risperidone, olanzapine, or aripiprazole were randomized to switch to iloperidone either gradually (ie, down-titration of current therapy over the first 2weeks [to 50% on Day 1, 25% by Week 1, 0% by Week 2]) or immediately. All patients were titrated on iloperidone to 6mg BID by Day 4, then flexibly dosing between 6 and 12mg BID, as needed. The primary variable was the Integrated Clinical Global Impression of Change (I-CGI-C) and the primary analysis time point was Week 12. A total of 500 patients were randomized and received iloperidone (gradual switch, 240; immediate switch, 260), with 175, 155, and 170 patients switched from risperidone, olanzapine, and aripiprazole, respectively. I-CGI-C Results confirmed improved outcomes at Week 12, with scores that were similar between the gradual- and immediate-switch groups, respectively, for risperidone, 2.82 and 2.67 (95% CI: -0.229, 0.511); olanzapine, 2.87 and 3.03 (95% CI: -0.548, 0.235); and aripiprazole, 2.79 and 2.81 (95% CI: -0.405, 0.368). Incidence of adverse events (AEs) was similar in both switch groups, with the most frequently reported (?10%) being dizziness, dry mouth, somnolence, and weight increase. In conclusion, switching to iloperidone by either a gradual or an immediate method did not reveal any clinically significant differences in ratings of overall efficacy and safety/tolerability outcomes, based on the I-CGI-C at 12weeks. Similar overall safety/AE profiles were observed regardless of the specific agent from which patients were switched.
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Switching antipsychotic medications to reduce adverse event burden in schizophrenia: establishing evidence-based practice.
J Clin Psychiatry
PUBLISHED: 12-17-2013
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The purpose of this project was to provide evidence-based guidance concerning when and how it is appropriate to undertake elective changes in antipsychotic medications in order to reduce adverse effects, with a focus on those adverse effects associated with increased long-term health risks. This project extends the results of the National Institute of Mental Health-funded 2009 Schizophrenia Patient Outcomes Research Team (PORT) psychopharmacologic treatment recommendations. The authors reviewed the literature on switching antipsychotics, focusing on randomized controlled trials published since the 2009 Schizophrenia PORT. The studies reviewed support a recommendation that an elective switch from higher to lower metabolic risk antipsychotics can produce weight and lipid benefits without significant risk of clinical deterioration. Evidence also suggests that certain antipsychotic switches may improve other adverse effects, including extrapyramidal symptoms and prolactin elevation. In deciding to make an elective change of antipsychotic medication, it is important to conduct a careful risk/benefit assessment with the patient. Before initiating a switch, patients should be educated about what to expect during the process. Studies also support gradual discontinuation of the current medication in order to minimize problems early in the switching process.
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Effectiveness of lurasidone in schizophrenia or schizoaffective patients switched from other antipsychotics: a 6-month, open-label, extension study.
CNS Spectr
PUBLISHED: 12-16-2013
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To evaluate the long-term safety and tolerability of lurasidone in schizophrenia and schizoaffective disorder patients switched to lurasidone.
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Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs.
J Clin Psychiatry
PUBLISHED: 03-04-2013
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Nonadherence is a major challenge in schizophrenia treatment. While long-acting (depot) antipsychotic medications are often recommended to address adherence problems, evidence on the comparative effectiveness of depot versus oral antipsychotics is inconsistent. We hypothesize that this inconsistency could be due to systematic differences in study design. This review evaluates the effect of study design on the comparative effectiveness of antipsychotic formulations. The optimal use of different antipsychotic formulations in a general clinical setting depends on better understanding of the underlying reasons for differences in effectiveness across research designs.
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The effect of an inpatient transition intervention on attendance at the first appointment postdischarge from a psychiatric hospitalization.
J Am Psychiatr Nurses Assoc
PUBLISHED: 10-04-2011
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Only 42% of initial appointments following psychiatric hospitalization are kept nationally. Missed appointments increase the likelihood of rehospitalization and increase costs of outpatient care.
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Why do patients with schizophrenia who have poor insight still take antipsychotics? Memory deficits as moderators between adherence belief and behavior.
J Psychiatr Pract
PUBLISHED: 09-20-2011
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While lack of insight is often predictive of antipsychotic nonadherence, some inconsistency in the literature remains unexplained. Verbal memory deficits may moderate the association between insight and adherence. Based on cross-sectional data, outpatients treated with antipsychotics for a psychotic disorder were divided into those with good (n=53) and poor (n=59) memory. Poor insight predicted nonadherence only among the subgroup with relatively good memory (r=0.43; P<0.01), but had no effect in the subgroup with worse memory (r=0.08; ns). Structural equation modelling revealed significant moderation (?=4.72; df=1; P<0.05), which means that a significantly better model fit was found by allowing the analysis to differentiate between the two memory groups. Thus, poor insight was only associated with poor medication adherence among patients with relatively good memory. We speculate that memory deficits commonly associated with schizophrenia may partly explain why poor insight does not always lead to poor medication adherence.
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Mid-term and long-term efficacy and effectiveness of antipsychotic medications for schizophrenia: a data-driven, personalized clinical approach.
J Clin Psychiatry
PUBLISHED: 02-10-2011
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Our aim in this article is 2-fold: first, to examine the mid-term to long-term data on efficacy, from controlled and naturalistic and other studies, in order to determine if they are consistent with the quantitative meta-analyses of mostly short-term, randomized controlled trials Our second (and most important) aim is to use these and other data to provide guidance about the potential relationship of these differences among antipsychotics to the individual patients own experience with antipsychotic drugs in the process of shared decision-making with the patients and their significant others.
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Why do persons with bipolar disorder stop their medication?
Psychopharmacol Bull
PUBLISHED: 12-15-2010
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Non-adherence to maintenance medication regimens is a major problem, limiting outcomes for many persons with bipolar disorder. The aim of this paper is to determine the most relevant aspects of adherence attitudes in a sample of bipolar patients selected for problems with adherence behavior.
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Strategies for addressing adherence problems in patients with serious and persistent mental illness: recommendations from the expert consensus guidelines.
J Psychiatr Pract
PUBLISHED: 09-23-2010
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Poor adherence to medication can have devastating consequences for patients with serious mental illness. The literature review and recommendations in this article are reprinted from The Expert Consensus Guideline Series: Adherence Problems in Patients with Serious and Persistent Mental Illness, published in 2009. The expert consensus survey (39 questions, 521 options) on adherence problems in schizophrenia and bipolar disorder was completed by 41 experts in 2008. This article first reviews the literature on interventions aimed at improving adherence. It then presents the experts recommendations for targeting factors that can contribute to nonadherence and relates them to the literature. The following psychosocial/programmatic and pharmacologic interventions were rated first line for specific problems that can lead to nonadherence: ongoing symptom/ side-effect monitoring for persistent symptoms or side effects; services targeting logistic problems; medication monitoring/environmental supports (e.g., Cognitive Adaptation Training, assertive community treatment) for lack of routines or cognitive deficits; and adjusting the dose or switching to a different oral antipsychotic for persistent side effects (also high second-line for persistent symptoms). Among pharmacologic interventions, the experts gave high second-line ratings to switching to a long-acting antipsychotic when lack of insight, substance use, persistent symptoms, logistic problems, lack of routines, or lack of family/ social support interfere with adherence and to simplifying the treatment regimen when logistic problems, lack of routines, cognitive deficits, or lack of family/social support interfere with adherence. Psychosocial/programmatic interventions that received high second-line ratings in a number of situations included medication monitoring/environmental supports, patient psychoeducation, more frequent and/or longer visits if possible, cognitive behavioral therapy (CBT), family-focused therapy, and services targeting logistic problems. It is important to identify specific factors that may be contributing to a patients adherence problems in order to customize interventions and to consider using a multifaceted approach since multiple problems may be involved.
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Methodological challenges in psychiatric treatment adherence research.
Clin Schizophr Relat Psychoses
PUBLISHED: 07-21-2010
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Reflecting an increasing awareness of the importance of treatment adherence on outcomes in psychiatric populations, the National Institute of Mental Health (NIMH) convened a panel of treatment adherence researchers on September 27-28, 2007 to discuss and articulate potential solutions for dealing with methodological adherence research challenges. Panel discussions and presentations were augmented with targeted review of the literature on specific topics, with a focus on adherence to medication treatments in adults with serious mental illness. The group discussed three primary methodological areas: participants, measures, and interventions. When selecting patients for adherence-enhancing interventions (AEIs), a three-tier model was proposed that draws from the universal (targeting all patients receiving medication treatment for a specific condition, regardless of current adherence), selective (targeting patients at risk for nonadherence), and indicated (targeting patients who are currently nonadherent) prevention model and emphasizes careful patient characterization in relevant domains and appropriate matching of interventions to the selected population. Proposals were also made to reduce problematic selection biases in patient recruitment and retention. The panel addressed the pros and cons of various methods that can be used to measure adherence, and concluded that it is appropriate to use multiple measures whenever possible. Finally, the panel identified a broad range of intervention approaches, and conditions under which these interventions are likely to be most effective at reducing barriers to adherence and reinforcing adherence behavior.
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A post hoc analysis of negative symptoms and psychosocial function in patients with schizophrenia: a 40-week randomized, double-blind study of ziprasidone versus haloperidol followed by a 3-year double-blind extension trial.
J Clin Psychopharmacol
PUBLISHED: 06-24-2010
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Schizophrenia is a persistent, lifelong illness such that enduring functional improvements may only occur over the course of years [corrected].This post hoc analysis in stable outpatients with schizophrenia investigated the negative symptom efficacy and treatment outcomes of ziprasidone (80-160 mg/d given twice a day, mean modal dose of 112 mg/d; and 80-120 mg/d given every day, mean modal dose of 96 mg/d) versus haloperidol (5-20 mg/d, mean modal dose of 12 mg/d) in a randomized, 40-week, double-blind study, followed by a double-blind continuation trial that extended up to 156 additional weeks. Symptomatic and functional recovery criteria were met when subjects attained both negative symptom remission and adequate psychosocial functioning based on the 4 Quality-of-Life subscales (instrumental role, interpersonal relations, participation in community, and intrapsychic foundations). Negative symptom remission (P = 0.005), as well as sustained adequate functioning (6 months) in instrumental role (P = 0.04) and participation in community (P = 0.02), was associated with significantly shorter time to remission in the ziprasidone 80 to 160 mg group than in the haloperidol group, as was the combination of symptomatic and functional recovery during the 196-week double-blind study period. A similar pattern was observed for the ziprasidone 80 to 120 mg group, which showed significant differences versus haloperidol in negative symptom remission and instrumental role functioning (but not other Quality-of-Life subscale measures). The clinically relevant outcome differences detected in this post hoc exploratory analysis support the potential for both enhanced remission in negative symptoms and psychosocial recovery during long-term treatment with an atypical agent and add to our understanding regarding the degree to which negative symptom remission can be attained in the maintenance phase.
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Assessment of adherence problems in patients with serious and persistent mental illness: recommendations from the Expert Consensus Guidelines.
J Psychiatr Pract
PUBLISHED: 01-26-2010
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Poor adherence to medication treatment can have devastating consequences for patients with serious mental illness. The literature review and recommendations in this article concerning assessment of adherence are reprinted from The Expert Consensus Guideline Series: Adherence Problems in Patients with Serious and Persistent Mental Illness, published in 2009. The expert consensus survey contained 39 questions (521 options) that asked about defining nonadherence, extent of adherence problems in schizophrenia and bipolar disorder, risk factors for nonadherence, assessment methods, and interventions for specific types of adherence problems. The survey was completed by 41 (85%) of the 48 experts to whom it was sent. When evaluating adherence, the experts considered it important to assess both behavior and attitude, although they considered actual behavior most important. They also noted the importance of distinguishing patients who are not willing to take medication from those who are willing but not able to take their medication as prescribed due to forgetfulness, misunderstanding of instructions, or financial or environmental problems, since this will affect the type of intervention needed. Although self- and physician report are most commonly used to clinically assess adherence, they are often inaccurate and may underestimate nonadherence. The experts believe that more accurate information will be obtained by asking about any problems patients are having or anticipate having taking medication rather than if they have been taking their medication; They also recommended speaking with family or caregivers, if the patient gives permission, as well as using more objective measures (e.g., pill counts, pharmacy records, smart pill containers if available, and, when appropriate, medication plasma levels). Use of a validated self-report scale may also help improve accuracy. For patients who appear adherent to medication, the experts recommended monthly assessments for adherence, with additional assessments if there is a noticeable symptomatic change. If there is concern about adherence, they recommended more frequent (e.g., weekly) assessments. The article concludes with suggestions for clinical interview techniques for assessing adherence.
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A New Psychosocial Tool for Gaining Patient Understanding and Acceptance of Long-acting Injectable Antipsychotic Therapy.
Psychiatry (Edgmont)
PUBLISHED: 09-03-2009
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Nonadherence to antipsychotic medications in serious, persistent mental illness remains a significant clinical challenge. Long-acting therapy was developed to help improve adherence to schizophrenia therapy and provide an effective means for ameliorating symptoms and preventing relapse. The Agency for Health Care Policy and Research/National Institute of Mental Health Schizophrenia Patient Outcomes Research Team recommends that antipsychotic long-acting therapy be strongly considered for patients who have difficulty adhering to an oral medication regimen or who prefer long-acting therapy. Depot conventional formulations have long been available; for clinicians and patients who would rather use an atypical antipsychotic, studies with risperidone long-acting therapy suggest that it is efficacious and well tolerated. A common concern of clinicians who elect to initiate long-acting therapy is how to introduce the possibility of changing from the current oral antipsychotic to an long-acting therapy injection. As with other aspects of patient care, having an established therapeutic relationship with the patient is advantageous for recommending changes in care, but the way in which the idea is approached may improve the likelihood of its acceptance. To help clinicians broach a recommendation of long-acting therapy with their patients, the GAIN approach was designed as a standard interview process for presenting this option. It encompasses (and is an acronym for) goal setting, action planning, initiating treatment, and nurturing motivation. This novel clinical tool is based on the principles of motivational enhancement therapy, a patient-centered approach that seeks to evoke the patients own motivation for change, to consolidate the decision to change, and to plan for change. This tool is also based on the Listen-Empathize-Agree-Partner, or LEAP, communication strategy. Motivational enhancement therapy, which is typically brief, has been found effective in several chronic illnesses in both outpatient and inpatient settings. GAIN may be a practical tool for aligning clinician-patient expectations and enhancing long-term maintenance of therapy.
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The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness.
J Clin Psychiatry
PUBLISHED: 08-19-2009
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Poor adherence to medication treatment can have devastating consequences for patients with mental illness. The goal of this project was to develop recommendations for addressing adherence problems to improve patient outcomes.
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Remission in schizophrenia: 196-week, double-blind treatment with ziprasidone vs. haloperidol.
Int. J. Neuropsychopharmacol.
PUBLISHED: 05-07-2009
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To compare the remission rate and its time-course over 196 wk of double-blind treatment with an atypical antipsychotic, ziprasidone (80-160 mg/d given b.i.d., or 80-120 mg/d given q.d.), or a conventional antipsychotic, haloperidol (5-20 mg/d). Outcome assessments included attainment of remission (Andreasen criteria) by longitudinal analysis. Positive and Negative Syndrome Scale (PANSS) scores, Global Assessment of Functioning Scale (GAF) scores, and quality-of-life (QLS) were also assessed in the initial 40-wk study phase (n=599) and the 3-yr extension study (n=186). Discontinuation rates in the initial 40-wk core and follow-up extension studies were comparable between groups: 64% and 65% for the 80-160 mg/d ziprasidone group, 65% and 58% for the 80-120 mg/d ziprasidone group, and 60% and 66% for the 5-20 mg/d haloperidol group, respectively. Mean change scores from baseline to LOCF endpoint (week 40 or early termination) for PANSS negative and GAF (primary efficacy variables) were not statistically significantly different between ziprasidone and haloperidol. During the 3-yr extension study, ziprasidone-treated subjects (80-160 mg/d) were more likely to achieve remission (51%) than haloperidol-treated (40%) subjects (p=0.04), while there was a favourable trend associated with 80-120 mg/d ziprasidone (48%). Compared to the haloperidol group, subjects assigned to the 80-160 mg/d ziprasidone group showed a gradual and persistent improvement in remission (p=0.006) and quality-of-life (p=0.004) in the longitudinal analyses. Significant differences in the trajectory of PANSS total and GAF scores favouring the 80-160 mg/d ziprasidone group were also observed. In this long-term, double-blind study, ziprasidone treatment was more likely to result in remission than haloperidol treatment, and was associated with greater improvement in quality-of-life.
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A randomized controlled trial of long-acting injectable risperidone vs continuation on oral atypical antipsychotics for first-episode schizophrenia patients: initial adherence outcome.
J Clin Psychiatry
PUBLISHED: 04-14-2009
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Nonadherence for first-episode schizophrenia is a major unsolved challenge. The long-acting injectable route is an appealing strategy, but there are concerns about acceptability. We report on acceptance and initial adherence outcomes with risperidone long-acting injection (RLAI) in first-episode schizophrenia patients.
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Proceedings and data from The Schizophrenia Summit: a critical appraisal to improve the management of Schizophrenia.
J Clin Psychiatry
PUBLISHED: 03-19-2009
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In mid-February 2008, a panel of 10 nationally recognized schizophrenia research experts was assembled in a Schizophrenia Summit to focus on controversies that exist in treating patients with schizophrenia. The current literature related to the diagnosis and etiopathology of schizophrenia was evaluated regarding the identification of a prodromal phase, brain changes, cognitive impairments, genetic factors, and use of neuroimaging in patients with schizophrenia. Further, consideration was given to evidence supporting the neuroprotective benefits of atypical antipsychotic medications, the benefits of treating patients during the prodromal period, the use of combination antipsychotic medications, the need to improve cognitive function, and the management of substance abuse. Summit faculty member opinion is compared with field survey results, and recommendations are made for future research.
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Implicit versus explicit attitudes toward psychiatric medication: Implications for insight and treatment adherence.
Schizophr. Res.
PUBLISHED: 03-05-2009
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Implicit attitudes are automatically activated evaluative impulses that are difficult to control and potentially outside conscious awareness. The association of implicit attitudes toward psychiatric medication with treatment adherence and insight was investigated in 85 persons with schizophrenia, schizoaffective, or affective disorders using the Brief Implicit Association Test. Explicit attitudes, insight, perceived need for treatment and adherence were measured by self-report. Implicit, but not explicit, positive attitudes predicted increased insight and perceived need for treatment. Explicit, but not implicit, positive attitudes predicted self-reported adherence. Implicit measures can improve our understanding of medication attitudes and evaluation of interventions to increase treatment adherence.
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Measurement of psychiatric treatment adherence.
J Psychosom Res
PUBLISHED: 02-11-2009
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Nonadherence to medications for mental disorders substantially limits treatment effectiveness and results in higher rates of relapse, hospitalization, and disability. Accurate measurement of medication adherence is important not only in adherence research but also in clinical trials in which medications are being evaluated and in clinical practice where failure to detect nonadherence results in premature medication changes, unnecessary polypharmacy, and greater likelihoods of functional deteriorations and hospitalizations. This is a review of psychiatric treatment adherence methods and measures arising from a meeting on "Methodological Challenges in Psychiatric Treatment Adherence Research" held on September 27-28, 2007, in Bethesda, MD, and organized by the National Institute of Mental Health (NIMH).
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Phenomenology of first-episode psychosis in schizophrenia, bipolar disorder, and unipolar depression: a comparative analysis.
Clin Schizophr Relat Psychoses
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Objective: This study sought to identify similarities and differences in symptom characteristics at initial presentation of first psychotic episodes in schizophrenia, bipolar disorder and unipolar depression. Methods: The Structured Interview for DSM-IV (SCID) and Positive and Negative Syndrome Scale (PANSS) were administered to consecutive admission study-eligible patients (n=101) presenting for treatment during their first acute phase of psychotic illness. Forty-nine percent of patients met diagnostic criteria for schizophrenia, 29% for psychotic bipolar disorder and 22% for unipolar depression with psychosis. The PANSS was analyzed using five-factor scoring that included Positive, Negative, Cognitive, Excitement, and Depression factors, and composite cluster scores that assessed Anergia, Thought Disturbance, and Paranoia. Results: Schizophrenia and bipolar disorder patients demonstrated significantly more Positive symptoms, Thought Disturbance and Paranoia than unipolar depressed patients. Schizophrenia and unipolar depressed patients demonstrated significantly more Negative symptoms and Anergia than bipolar patients. Patients with schizophrenia reported more severe Cognitive Disorganization than patients with either bipolar disorder or uni-polar depression (p<.05). Conclusions: Findings from this study demonstrate an informative pattern of similarities and differences in the phenomenology of psychotic disorders at first illness presentation. Commonalities in symptom profiles reflect considerable symptom overlap among psychotic disorders and, thus, the importance of multidimensional differential diagnosis for these conditions. The differences across disorders in Positive and Negative symptom severity, Thought Disorder, Paranoia, and Anergia, and especially the higher level of Cognitive Disorganization seen in schizophrenia patients, point to clinically informative differences across these disorders that are relevant to clinical diagnostic practice and models of psychopathology.
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Maintenance treatment with long-acting injectable risperidone in first-episode schizophrenia: a randomized effectiveness study.
J Clin Psychiatry
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Because long-acting injectable (LAI) antipsychotics are largely reserved for persistently ill patients, little is known about the use of LAIs early in the course of illness for first-episode outpatients.
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Paliperidone palmitate injection for the acute and maintenance treatment of schizophrenia in adults.
Patient Prefer Adherence
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To review the use of paliperidone palmitate in treatment of patients with schizophrenia.
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Iloperidone for the treatment of schizophrenia: an updated clinical review.
Clin Schizophr Relat Psychoses
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Iloperidone is a second-generation "atypical" antipsychotic whose primary mechanism of action is within the subclass of combined D2/5HT2A antagonism. Iloperidone was approved by the FDA in May 2009 for the treatment of schizophrenia. This review is a comprehensive synthesis of the history and clinical trials data leading up to approval, and evaluates iloperidone within the clinical context of how it compares with other available antipsychotics.
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Early Perception of Medication Benefit Predicts Subsequent Antipsychotic Response in Schizophrenia.
Clin Schizophr Relat Psychoses
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Background: An easy-to-administer tool for predicting response to antipsychotic treatment could improve the acute management of patients with schizophrenia. We assessed whether a patients perception of medication benefit early in treatment could predict subsequent response or non-response to continued use of the same treatment.Method: This post-hoc analysis used data from a randomized, open-label trial of antipsychotics for treatment of schizophrenia in which attitudes about medication adherence was assessed after 2 weeks of antipsychotic treatment using the Rating of Medication Influences (ROMI) scale. The analysis included 439 patients who had Positive and Negative Syndrome Scale (PANSS) and ROMI scale data at Weeks 2 and 8. Scores on the ROMI subscale Perceived Medication Benefit factor were used to predict subsequent antipsychotic response at Week 8, defined as a ?20% reduction from baseline on the PANSS. Logistic regression was used to identify a cut-off score for the Perceived Medication Benefits factor that could accurately identify antipsychotic responders vs. nonresponders at Week 8.Results: A score of ?2.75 (equal to a mean subscale score of ?11.00) on the ROMI scale Perceived Medication Benefit factor at Week 2 predicted response at Week 8 with high specificity (72%) and negative predictive value (70%), moderate sensitivity (44%) and positive predictive value (47%), and with a 38% misclassification rate.Conclusion: A brief assessment of the patients perception of medication benefit at 2 weeks into treatment appears to be a good predictor of subsequent response and non-response after 8 weeks of treatment with the same antipsychotic.
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Reasons for adherence and non-adherence.
Clin Schizophr Relat Psychoses
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Rationale: Most first-episode schizophrenia patients will stop their medication after their acute symptoms improve. Understanding the salient motivations and attitudes that drive adherence as well as nonadherenceis an important part of developing strategies to prevent or delay nonadherence during the early phases of the illness.Methods: Self-reported reasons for adherence and nonadherence among first-episode and multi-episode patients with schizophrenia were obtained from cross-sectional adherence interviews from two prospective adherence studies, one composed of first-episode sample (n=33) and the other with recently relapsing multi-episode patients (n=16). Both groups received the Rating of Medication Influences Scale (ROMI) at approximately 16 - 20 weeks after an acute psychotic episode. The specific ROMI items were ranked in order of percentage (%) strong, and were compared both within each patient group for rank order of importance, and also compared between groups to determine the differences in specific adherence and nonadherence influences.Results: The doctor-patient relationship was more likely to be endorsed as a strong adherence influence in the first-episode sample (74%) than in the multi-episode sample (13%, X2= 18.07, p<.01). Change in physical appearance attributed to medication was a more commonly endorsed nonadherence influence for the multi-episode sample (25%) relative to the first-episode sample (0%, X2=9.2, p<.01).Conclusion: The doctor-patient relationship stands out as being the major reason for ongoing adherence for first-episode schizophrenia patients. Our post-hoc interpretation is that lack of prior experience with medication and treatment elevates the importance of the relationship with the treating clinician for first episode patients.
Related JoVE Video

What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.