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An explanation of the role of family participation in a medication information program on schizophrenic clients' medication adherence behaviorsIngram, Judy January 1987 (has links)
The purpose of this study was to describe family members' influence on medication adherence rates for schizophrenic clients following an educational program presented simultaneously to both client and family member. Three chronic schizophrenic clients participated in this study, two were females, and the other was male. The two family members who provided data were husbands of the two female clients. The obtained scores and responses of two questionnaires was indicative of improved medication adherence for clients and family members. The level of adherence was similarly perceived by the clients and their family members as obtained scores and responses were similar across both time periods. However, family members' attendance at the program presentation did not influence the level of reported medicated adherence behaviors of their wives as compared to the client who attended the program alone because the greatest increase in obtained scores was reported by the client who attended the program alone.
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Prospective memory and medication adherence in schizophrenia : influencing factors and awareness of abilitiesRitch, Janice Lorraine 31 August 2012 (has links)
Adherence to antipsychotic medication in schizophrenia has been shown to predict symptom exacerbations; however, adherence remains poor in this population. The concept of taking medication on a maintenance regime is an example of prospective memory (PM). The current investigation is comprised of three studies in which 59 outpatients diagnosed with schizophrenia completed a comprehensive assessment including measures of PM, executive functioning, comprehension of medication instructions, insight into the need for medication, and environmental variables supporting adherence. An objective measure of medication adherence was also collected during a one-month baseline period. In study 1, medication adherence was conceptualized as a PM task and variables for predicting adherence based on PM literature were examined. Of the hypothesized variables, the interactive effect of PM ability and comprehension of medication instructions was the only predictor of adherence to antipsychotic medication. Comprehension of medication instructions alone was the only predictor of adherence to total psychotropic medication regime. Study 2 investigated the role of executive functions in the awareness of PM deficits and use of compensatory strategies. Results indicated that patients with poorer executive skills were less reliable in their report of PM ability compared to performance on PM measures. However, both fair and poor executive functioning groups reported similar use of compensatory strategies. Lastly, the third study manipulated the specificity of retrieval context for a 5-day habitual PM task intended to mimic medication-taking. The aim of this investigation was to examine the effect of retrieval context specificity and executive functioning on task performance. Results demonstrated that patients categorized as fair executive functioning completed significantly more days of the habitual task than patients categorized as poor executive functioning. There was no difference in performance between patients receiving greater retrieval context specificity versus patients receiving a general context. However, there was a trend for individuals with fair executive functioning to benefit from greater retrieval context specificity, implying that a minimum level of executive skill may be necessary for individuals to recognize the risk of a restricted retrieval interval and/or mobilize additional resources for encoding. Clinical implications are discussed. / text
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Studies in the psychopathology, neurobiology and psychopharmacology of schizophreniaEmsley, Robin 03 1900 (has links)
Dissertation (DSc)-- Stellenbosch University, 2008. / ENGLISH ABSTRACT: The overall aim of these studies was to investigate selected aspects of psychopathology,
neurobiological abnormalities and treatment in schizophrenia.
The following topics were researched:
1. Psychopathology:
We explored the symptom structure of schizophrenia by means of principal
components and factor analysis in two separate samples.
a. The first study investigated the nature of symptoms in patients with a first-episode
of schizophrenia, in a large cohort of patients who were participating in a
multinational clinical trial. We compared our findings with similar analyses
previously conducted in multi-episode schizophrenia patients.
b. We then assessed the influence of culture on the symptom structure of
schizophrenia by conducting a principal components and factor analysis of the
symptom ratings in a large sample of South African Xhosa patients with
schizophrenia, and comparing the results with those in other parts of the world.
c. We investigated the occurrence of co-morbid depressive and anxiety symptoms,
and their demographic and clinical correlates. The sample for this study
comprised acutely psychotic patients who were participants in clinical drug trials
conducted at our centre.
d. To explore the relationships between obsessive-compulsive disorder and
schizophrenia, we conducted a review of the relevant literature.
2. Neurobiological abnormalities:
a. We performed a series of studies to investigate disorders of water homeostasis
and vasopressin secretion in schizophrenia. To test the hypothesis that acutely
psychotic patients have disordered regulation of water homeostasis, we applied a
dynamic suppression test - a water loading test, with assessment of excretory
capacity (including arginine vasopressin assay) in acutely psychotic patients. To
evaluate whether a subset of patients with schizophrenia and co-morbid
disordered water homeostasis sustained cerebral damage as a consequence of
water intoxication we did the following experiment: We identified a cohort of
subjects with schizophrenia and disordered water homeostasis and compared
them with patients with schizophrenia without disordered water homeostasis in
terms of cerebral ventricular size and cognitive function. To assess the
prevalence of disordered water homeostasis in a long-term inpatient sample of
psychiatric patients we conducted serum sodium screening tests. Those subjects
with dilutional hyponatraemia were then further investigated for dysregulation of
water homeostatic mechanisms.
b. We studied neurological soft signs in a sample of subjects with first-episode
schizophrenia followed up over a two year period. We investigated their
occurrence, relationships to psychiatric symptoms and medication effects, their temporal stability and their outcome correlates. We also investigated their
potential to predict outcome in schizophrenia
3. Treatment aspects
A great deal of our work has focussed on the pharmacological treatment of schizophrenia.
The following aspects of treatment are included in this thesis:
a. Treatment effects on psychiatric symptoms:
i. To assess the effects of ethnicity on treatment outcome in schizophrenia
we compared the acute response to antipsychotic treatment in 3 ethnic
groups, namely blacks, coloureds and whites. We included patients in
this analysis who had participated in clinical trials in our department as
well as the Department of Psychiatry in the University of the Free Sate.
Patients had been treated under blinded conditions over a 6-week period.
ii. After discussions with the late Dr David Horrobin, who had pioneered
possible applications of the omega-3 fatty acids in the treatment of
various psychiatric disorders, we became interested in further
investigating the potential of this group of compounds as an affordable
adjunct to treating schizophrenia. We assessed the antipsychotic
potential of the omega-3 fatty acid, ethyl-eicosapentaenoic-acid (e-EPA)
supplementation versus placebo supplementation in a small sample of
subjects with schizophrenia who had been only partially responsive to
antipsychotic treatment previously. We also conducted a review of the
literature to evaluate the evidence for efficacy for the omega-3 fatty acids
in schizophrenia according to published studies.
b. Treatment effects on neurological abnormalities:
i. In a single-blinded controlled study we compared a new generation
antipsychotic to a conventional antipsychotic in the treatment of tardive
dyskinesia (TD). This was a long-term (1 yr) study in patients with
chronic schizophrenia and established tardive dyskinesia.
ii. We also assessed the effect of omega-3 fatty acid (e-EPA)
supplementation in treating TD. This was conducted in a larger sample
(n=84) of patients with chronic schizophrenia and established TD. The
blinded, placebo-controlled phase was 12 weeks. This was followed by
an open-label extension for 40 weeks.
c. Conventional versus new generation antipsychotic agents.
Several evidence-based literature reviews of the efficacy and tolerability of
the new generation of antipsychotics compared to the conventional agents
were conducted. Some multinational, randomised, controlled clinical trials in
which the author was principal investigator, are included in this thesis. Also,
studies addressing patients with partial treatment refractoriness are included,
as well as studies of the effects of antipsychotics on depressive symptoms, body mass and glycaemic control. Finally, we have included a pharmacoeconomic
study comparing a conventional antipsychotic (haloperidol) with a
new generation antipsychotic (quetiapine) in partially refractory patients in a
South African setting.
Findings and conclusions:
1. Psychopathology:
Our studies demonstrated that the factor structure for the symptoms of schizophrenia is
replicable across samples, and is not greatly influenced by ethnic and cultural factors.
However, changes in the factor structures do occur over time. There are symptom domains
that are present in first-episode schizophrenia but disappear as a distinct entity as the illness
becomes chronic. Particularly, a motor component is evident in untreated patients, but
disappears after initiation of treatment. We found that depression and anxiety are common
co-morbid symptoms in schizophrenia, and have important clinical and outcome correlates.
Depressive symptoms in the acute psychotic phase of schizophrenia are associated with a
favourable prognosis and diminish as the symptoms of psychosis improve in response to
antipsychotic treatment. However, persistent depressive symptoms are associated with a
poorer prognosis, and require additional therapeutic intervention.
2. Neurobiological abnormalities:
We investigated the occurrence of disordered water regulation in a population of psychiatric
inpatients, and conducted further investigations on those identified, in order to establish
mechanisms involved. Polydipsia and the syndrome of inappropriate antidiuretic hormone
secretion (SIADH) were found to occur in a subset of patients with schizophrenia, and are
associated with acute psychosis, as well as with some psychotropic medications. These
patients are characterised by more severe cognitive impairment and evidence of cerebral
atrophy. The condition can become life-threatening in the presence of other factors impeding
water excretion, particularly thiazide diuretics.
Neurological soft signs were investigated in a sample of patients with a first-episode of
schizophrenia. These soft signs appear to be trait-like (present early in the illness, and stable
over time), except for a motor sequencing factor. Patients performing poorly on this latter
group of tests have a longer duration of untreated psychosis, and are at significant risk for
developing TD.
3. Treatment aspects:
Our studies suggest that there are important ethnic differences in antipsychotic treatment
response, but that these differences could be explained by a number of environmental and
biological factors. As was found with many studies worldwide, we found that the new generation antipsychotics have important efficacy and safety advantages over their
predecessors. Risperidone was as effective as haloperidol in first-episode psychosis, but with
a more favourable side-effect profile in terms of reduced extrapyramidal symptoms.
Quetiapine treatment in partially refractory patients resulted in more responders compared to
haloperidol, and fewer extrapyramidal symptoms. However, evidence of a different side-effect
profile is emerging. Of particular concern is the finding that some of the new antispychotics
cause weight gain, glucose intolerance and dyslipidaemias. We found that one novel
antipsychotic, quetiapine, was not associated with significantly more weight gain or
disordered glucose metabolism that a conventional agent, haloperidol. The omega-3 fatty
acids, particularly EPA may have a role in the treatment of various psychiatric disorders. Our
studies provided mixed results – the first found a significant beneficial effect on psychotic
symptoms and dyskinesia scores for EPA supplementation, while the second failed to
demonstrate a beneficial effect on TD or psychotic symptoms. We explored the early
treatment response in first-episode psychosis and found, unlike that reported in multi-episode
patients, some patients took a long time to respond. We also found that early treatment
response was a significant predictor of later remission, as was duration of untreated
psychosis, educational level and baseline excitement factor scores. Finally, our
pharmacoeconomic study conducted for South African circumstances in patients with a partial
response to conventional antipsychotic treatment showed cost-neutrality or cost-benefits for
quetiapine compared with haloperidol treatment for direct costs. / AFRIKAANSE OPSOMMING: Die oorkoepelende doel van hierdie studies was om geselekteerde aspekte van
psigopatologie, neurobiologiese abnormaliteite en behandeling in skisofrenie te ondersoek.
Die volgende onderwerpe is nagevors:
4. Psigopatologie:
Ons het die simptoomstruktuur van skisofrenie ondersoek deur middel van
hoofkomponent- en faktoranalise in twee aparte steekproewe.
a. Die eerste studie het die aard van simptome in pasiënte, met ʼn eerste-episode
van skisofrenie, ondersoek in ʼn groot kohort van pasiënte wat deelgeneem het
aan ʼn multi-nasionale kliniese proefneming. Ons het ons bevindinge vergelyk met
soortgelyke analises wat voorheen gedoen is in multi-eposode skisofrenie
pasiënte.
b. Hierna het ons die invloed van kultuur op die simptoom struktuur van skisofrenie
geassesseer deur ʼn hoofkomponent- en faktoranalise van die simptoomtellings
uit te voer in ʼn groot steekproef van Suid-Afrikaanse Xhosa pasiënte met
skisofrenie en die resultate te vergelyk met bevindinge in ander dele van die
wêreld.
c. Ons het die voorkoms van ko-morbiede depressiewe en angssimptome
ondersoek, asook hul demografiese en kliniese korrelate. Die steekproef vir
hierdie studie het bestaan uit akute psigotiese pasiënte wat deelnemers was in ʼn
kliniese geneesmiddel proef wat uitgevoer is by ons sentrum.
d. Om die verband tussen obsessief-kompulsiewe steurnis en skisofrenie te verken,
het ons ʼn oorsig van die relevante literatuur gedoen.
5. Neurobiologiese abnormaliteite:
a. Ons het ʼn reeks studies uitgevoer om steurnisse in water homeostase en
vasopressien sekresie in skisofrenie te ondersoek. Om die hipotese dat akute
psigotiese pasiënte versteurde regulering van water homeostase het te
ondersoek, het ons ʼn dinamiese onderdrukkingstoets toegepas – ʼn water
ladingstoets, met assessering van ekskresiekapasiteit (insluitend arginien
vasopressien essai) in akute psigotiese pasiënte. Om te evalueer of ʼn
onderafdeling van skisofrenie pasiënte met ko-morbiede versteurde water
homeostase serebrale skade opgedoen het as gevolg van water intoksikasie, het
ons die volgende eksperiment uitgevoer: Ons het ʼn kohort deelnemers met
skisofrenie en versteurde water homeostase geïdentifiseer en hulle vergelyk met
skisofrenie pasiënte sonder versteurde water homeostase in terme van serebrale
ventrikulêre grootte en kognitiewe funksionering. Om die voorkoms van
versteurde water homeostase in ʼn langtermyn binne-pasiënt steekproef van
psigiatriese pasiënte te bepaal, het ons serum natrium siftingstoetse uitgevoer.
Deelnemers met hiponatremie is hierna verder ondersoek vir disregulering van
water homeostatiese meganismes. b. Ons het neurologiese sagte tekens in ʼn steekproef van deelnemers met eersteepisode
skisofrenie bestudeer en opgevolg oor ʼn twee jaar tydperk. Ons het hulle
voorkoms, verwantskappe met psigiatriese simptome en medikasie effekte, hulle
temporale stabiliteit en hul uitkoms korrelate ondersoek. Ons het ook hulle
potensiaal om die uitkoms in skisofrenie te voorspel, ondersoek.
6. Behandelings aspekte
ʼn Groot meerderheid van ons werk het gefokus op die farmakologiese behandeling van
skisofrenie. Die volgende aspekte van behandeling is ingesluit in hierdie tesis:
a. Behandelingseffekte op psigiatriese simptome:
i. Om die effek van etnisiteit op behandelingsuitkoms in skisofrenie te
assesseer, het ons die akute respons op anti-psigotiese behandeling in 3
etniese groepe vergelyk, naamlik swart, gekleurd, en wit. Ons het
pasiënte wat deelgeneem het aan kliniese proefnemings in ons
departement sowel as die Departement Psigiatrie van die Universiteit van
die Vrystaan ingesluit in hierdie analise. Pasiënte is behadel onder
geblinde toestande oor ʼn tydperk van 6 weke.
ii. Na besprekings met wyle Dr David Horrobin, wie die moontlike
toepassings van omega-3 vetsure in die behandeling van verskeie
psigiatreise steurnisse gepionier het, het ons begin belangstel in verdere
ondersoek na die potensiaal van hierdie groep samestellings as ʼn
bekostigbare toevoeging in die behandeling van skisofrenie. Ons het die
anti-psigotiese potensiaal van die omega-3 vetsuur, etieleikosapentanoësuur
(e-EPA) supplementasie versus plasebo
supplementasie ondersoek in ʼn klein steekproef van deelnemers met
skisofrenie wat slegs gedeeltelik responsief was op anti-psigotiese
behandeling in die verlede. Ons het ook ʼn literatuuroorsig gedoen om die
bewyse vir die effektiwiteit vir die omega-3 vetsure in skisofrenie te
evalueer volgens gepubliseerde studies.
b. Behandelingseffekte op neurologiese abnormaliteite:
i. In ʼn enkelblinde kontrole studie het ons ʼn nuwe generasie anti-psigotiese
medikasie vergelyk met ʼn konvensionele anti-psigotiese medikasie in die
behandeling van tardiewe diskinesie (TD). Hierdie was ʼn langtermyn (1-
jaar) studie in pasiënte met chroniese skisofrenie en vasgestelde TD.
ii. Ons het ook die effek van omega-3 vetsuur (e-EPA) suplementasie
geassesseer in die behandeling van TD. Dit was gedoen in ʼn groter
steekproef (n=84) van pasiënte met chroniese skisofrenie en vasgestelde
TD. Die blinde, placebo kontrole fase was 12 weke. Dit is gevolg deur ʼn
nie-geblinde ekstensie vir 40 weke.
c. Konvensionele versus nuwe generasie anti-psigotiese agente. Verskeie bewys-gebaseerde literatuuroorsigte oor die effektiwiteit en
toleransie van die nuwe generasie anti-psigotiese agente in vergelyking met
die konvensionele agente, is gedoen. Sommige multi-nasionale, ewekansige,
kontole kliniese proefnemings waarin die outeur die hoofnavorser was, is
ingesluit in hierdie tesis. Verder, studies wat die pasiënte met gedeeltelike
behandelingsweerstandigheid aanspreek, is ingesluit, sowel as studies oor
die effekte van anti-psigotiese agente op depressiewe simptome,
liggaamsmassa en glisemiese kontrole. Laastens, het ons a farmakoekonomiese
studie ingesluit wat die konvensionele anti-psigotiese
behandeling (haloperidol) met ʼn nuwe generasie anti-psigotiese behandeling
(quetiapien) in gedeeltelik weerstandige pasiënte in ʼn Suid-Afrikaanse ligging
vergelyk.
Bevindinge en gevolgtrekkings:
4. Psigopatologie:
Ons studies het gedemonstreer dat die faktor struktuur vir die simptome van skisofrenie
herhaalbaar is oor steekproewe, en dat dit nie grootliks beïnvloed word deur etnisiteit en
kulturele faktore nie. Veranderinge vind egter in die faktor strukture wel plaas met verloop van
tyd. Daar is simptoom domeine wat teenwoordig is in eerste-episode skisofrenie, maar
verdwyn as ʼn afsonderlike entiteit soos wat die toestand chronies word. Spesifiek, ʼn
motoriese komponent is duidelik in onbehandelde pasiënte, maar verdwyn na die aanvang
van behandeling. Ons het gevind dat depressie en angs algemene ko-morbiede simptome in
skisofrenie is en het belangrike kliniese en uitkoms korrelate. Depressiewe simptome in die
akute psigotiese fase van skisofrenie word geassosieer met ʼn gunstige prognose en
verminder soos wat die simptome van psigose verbeter in repons op anti-psigotiese
behandeling. Egter, volgehoue depressiewe simptome word geassosieer met ʼn swakker
prognose en benodig addisionele terepeutiese intervensie.
5. Neurobiologiese abnormaliteite:
Ons het die voorkoms van versteurde water regulering ondersoek in ʼn populasie van
psigiatriese binne-pasiënte en verdere ondersoek ingestel op dié wie geïdentifiseer is, om die
betrokke meganismes vas te stel. Polidipsie en en die sindroom van onvoldoende antidiuretiese
hormoon sekresie (SIADH) is gevind om voor te kom in ʼn onderafdeling van
pasiënte met skisofrenie, en word geassosieer met akute psigose sowel as met somige
psigotropiese medikasie. Hierdie pasiënte word gekenmerk deur meer ernstige kognitiewe
beperking en bewyse van serebrale atrofie. Die toestand kan lewensbedreigend raak in die
teenwoordigheid van ander faktore wat water ekskresie hinder, veral tiasied diuretikums. Neurologiese sagte tekens is ondersoek in ʼn steekproef van pasiënte met eerste-episode
skisofrenie. Hierdie sagte tekens blyk om kenmerkend (teenwoordig vroeg in die siekte, en
stabiel oor tyd) te wees, behalwe vir ʼn motoriese volgorde faktor. Pasiënte wat swak vaar op
die laasgenoemde groep toetse, het ʼn langer durasie van onbehandelde psigose, en het ʼn
beduidende risko om TD te ontwikkel.
6. Behandeling aspekte:
Ons studies stel voor dat daar ʼn belangrigke etniese verskil is in anti-psigotiese
behandelingsrespons, maar dat hierdie verskille verduidelik kan word deur ʼn aantal
omgewings- en biologiese faktore. Soos wat gevind was vir verskeie studies wêreldwyd, het
ons gevind dat die nuwe generasie anti-psigotiese agente belangrike effektiwiteit- en
veiligheidsvoordele het bo hulle voorgangers. Risperidoon was net so effektief as haloperidol
in eerste-episode psigose, maar met ʼn meer gunstige newe-effkte profiel in terme van
verminderde ekstrapirimidale simptome. Quetiapien behandeling in veral refraktêre pasiënte
het gelei tot meer respondeerders vergeleke met haloperidol, en minder ekstra pirimidale
simptome. Alhoewel, bewyse van ʼn verskillende newe-effekte profiel is besig om na vore te
kom. Van spesifieke belang is die bevinding dat sommige van die nuwe anti-psigotiese
agente gewigstoename, glukose intoleransie en dyslipidemie veroorsaak. Ons het gevind dat
een nuwe anti-psigotiese agent, quetiapien, nie geassosieer was met enige beduidende meer
gewigstoename of versteurde glukose metabolisme as ʼn konvensionele agent, haloperidol,
nie. Die omega-3 vetsure, spesifiek EPA mag moontlik ʼn rol in die behandeling van verskeie
psigiatriese versteurings hê. Ons studies het gemengde resultate voorsien – die eerste het ʼn
beduidende voordelige effek op psigotiese simptome en diskinesie tellings vir EPA
supplementasie gevind, terwyl die tweede nie ʼn voordelige effek op TD of psigotiese
simptome gevind het nie. Ons het die vroeë behandelingsrespons ondersoek in eersteepisode
pasiënte en het gevind, in teenstelling met dit wat gerapporteer word in multi-episode
pasiënte, dat sommige pasiënte ʼn lang tyd geneem het om te reaggeer. Ons het ook gevind
dat vroeë behandelingsrespons ʼn beduidende voorspeller was van latere remissie, so ook die
durasie van onbehandelde psigose, opvoedingspeil, en basisvlak opwindings-faktor tellings.
Laastens het ons farma-ekonomiese studie, wat uitgevoer is vir Suid-Afrikaanse
omstandighede in pasiënte met ʼn gedeeltelike repons op konvensionele anti-psigotiese
behandeling, koste-neutraliteit of koste-voordele aangetoon vir quetiapien vergeleke met
haloperidol behandeling vir direkte onkostes.
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Treatment of first episode schizophrenia with low-dose haloperidol : a study in the Western Cape Province of South AfricaOosthuizen, P. P. (Petrus Paulus) January 1900 (has links)
Dissertation (PhD)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: Although schizophrenia is traditionally viewed as an illness with a very poor
prognosis, research over the last few years indicates that early intervention may
substantially improve the long-term outcome of this disorder. Several studies
suggest that patients with first-episode psychosis (FEP) are more sensitive to,
and require lower doses of antipsychotic medications than patients with more
chronic forms of illness. However, the optimal dose of first-generation
anti psychotics in patients with FEP has not been explored extensively and
continues to be a controversial subject. This study evaluated the efficacy and
safety of low-dose haloperidol in a South African cohort with FEP.
The study was conducted in two phases:
Phase 1 was an open-label, naturalistic study of 57 subjects with FEP who were
commenced on 1mg of haloperidol for 4 weeks, after which gradual escalation of
doses were allowed, if required. Subjects who failed to respond at haloperidol
10mg per day were switched to thioridazine. Failure to respond to thioridazine
600mg per day was interpreted to indicate treatment resistance. These subjects
were then commenced on clozapine. The principal finding of this phase of the
study was that the majority of subjects could be stabilized and maintained on
very low doses of haloperidol (1.7 ± 1.0 mg/day at 12 months and 1.3 ±0.8
mg/day at 24 months). Ratings for extra-pyramidal side-effects did not increase
significantly from baseline over the duration of the study, except in the case of
tardive dyskinesia (TD), where a substantial number of subjects (12.3%)
developed TD within 12 months of starting treatment. Phase 2 of the study was a double-blind, randomized controlled trial of low-dose
(2mg/day) versus "standard dose" (8mg Iday) haloperidol. Forty subjects were
included in this phase of the study; 20 in each treatment arm. The main finding
was that there were no significant differences in treatment reponse between the
two treatment groups. There were, however, significant differences between the
two treatment groups in extrapyramidal side effects (EPSE), with the 8mg per
day group exhibiting significantly higher levels of EPSE than the 2mg per day
group. This was manifested by significant differences in scores on the
Extrapyramidal Symptom Rating Scale (ESRS) and the Simpson-Angus Rating
Scale. Furthermore, subjects in the 8mg haloperidol per day group required
significantly higher doses of anticholinergic medication and had significantly
higher mean levels of prolactin at the end of the study period.
This study indicates that a majority of subjects with first-episode psychosis can
be treated and maintained successfully with very low doses of haloperidol. It also
shows that low-dose treatment is as effective as, and better tolerated than,
"standard" doses. Despite the success with the low-dose treatment, however,
there was still a much higher than expected incidence of tardive dyskinesia, a
serious and potentially irreversible side-effect of neuroleptic treatment. / AFRIKAANSE OPSOMMING: Hoewel skisofrenie tradisioneel gesien is as 'n siekte met 'n uiters swak
prognose, dui navorsing oor die afgelope jare daarop dat vroeë ingryping
die langtermynuitkoms van hierdie toestand drasties mag verbeter. Resultate van
verskeie studies dui daarop dat pasiënte met eerste-episode psigose (EEP) nie
net meer sensitief is vir antipsigotiese middels nie, maar ook laer dosisse
daarvan benodig tydens behandeling as pasiënte met meer kroniese vorms van
psigotiese siekte. Desondanks is die kwessie van die korrekte dosis van eerste
generasie antipsigotika in hierdie groep nog onvolledig nagevors en bly dit 'n
omstrede onderwerp. Hierdie studie het ten doel gehad om die effektiwiteit en
veiligheid van lae dosis haloperidol in 'n Suid-Afrikaanse populasie van pasiënte
met EEP te evalueer.
Die studie is uitgevoer in twee fases:
Fase 1 was 'n oop, naturalistiese studie van 57 pasiënte met EEP wat
aanvanklik behandel is met 1mg haloperidol per dag vir 4 weke, waarna
geleidelike verhoging van dosisse toegelaat is, soos nodig. Diegene wat nie
bevredigende respons getoon het op haloperidol 10mg per dag nie, is
oorgeskakel na tioridasien. Ontoereikende respons teen 600mg/dag tioridasien is geïnterpreteer as 'n aanduiding van behandelingsweerstandigheid en
behandeling met klosapien is begin.
Die belangrikste bevinding van hierdie fase van die studie was dat die
meerderheid pasiënte gestabiliseer en in stand gehou kom word op baie lae
dosisse haloperidol (1.7 ± 1.0 mg/dag op 12 maande en 1.3 ±0.8 mg/dag op 24
maande).
Metings van ekstra-piramidale newe-effekte (EPNE) het nie beduidend
toegeneem oor die duur van die studie nie, behalwe in die geval van
tardiewe diskinese (TO), waar 'n beduidende aantal pasiënte (12.3%) TO
ontwikkel het binne 12 maande na aanvang van behandeling.
Fase 2 van die studie was 'n dubbelblinde, ewekansig gerandomiseerde studie
waarin behandeling met lae dosis haloperidol (2mg/dag) vergelyk is met
"standaard" dosis haloperidol (8mg/dag).
Veertig pasiënte is ingesluit in hierdie fase van die studie, 20 in elke
behandelingsarm. Die hoofbevinding was dat daar geen beduidende verskille in
respons op behandeling was tussen die twee groepe nie.
Daar was egter beduidende verskille in EPNE, waar die 8mg/dag groep
beduidend hoër vlakke van EPNE gehad het as die 2mg/dag groep.
Hierdie verskil in EPNE is aangedui deur 'n statisties beduidende verskil in
tellings op die Extrapyramidal Symptom Rating Scale (ESRS) en die Simpson-
Angus Rating Scale. Verder het pasiënte in die 8mg/dag groep beduidend hoër
dosisse antikolinerge medikasie benodig en ook hoër gemiddelde
prolaktienvlakke gehad teen die einde van studie. Hierdie studie dui dus daarop dat die meerderheid van pasiënte met EEP
suksesvol behandel en in stand gehou kan word met baie lae dosisse
haloperidol. Die studie wys ook daarop dat behandeling met lae dosisse net so
effektief is en beter verdra word as behandeling met "standaard" dosisse. Ten
spyte van die suksesvolle gebruik van lae dosisse medikasie het die studie egter
ook getoon dat daar "n baie hoër as verwagte insidensie was van TO, "n emstige
en potensieelonomkeerbare newe-effek van neuroleptiese behandeling.
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Providing behavioral data to physicians for enhancing medication treatment for chronically mentally disabled individualsPatterson, Nona L. 01 January 1987 (has links)
Physicians are often unaware of mentally disabled outpatients' symptomatic behaviors that are relevant to their medication prescriptions. Such information is available to the clients' residential care providers . The present study trained clients' residential care providers in data collection and provided these data to physicians. It was predicted that these data would improve medication treatment for these clients and consequently lead to a decrease in client's symptomatic behaviors . The results did not confirm the predictions; the data provided to physicians on clients' between- visit behaviors had no measured effect on the physicians' treatment of these clients, although the physicians reported positive attitudes about the helpfulness and utility of ·the system .
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Implementation of international treatment guidelines in the treatment of schizophrenia : a study of the effects of an evidence-based seminar on the knowledge and treatment habits of a sample of international psychiatristsJoubert, Andre Francois 12 1900 (has links)
Thesis (DMed (Psychiatry))--University of Stellenbosch, 2007. / This study reports on the effect of seminar education by studying changes in knowledge, attitude and behaviour to haloperidol prescribing patterns of psychiatrists who In summary, this study demonstrated a direct relationship between seminar attendance and changes to selected minimum effective haloperidol dose and duration of treatment. However, seminar attendance did not appear to be a significant factor in changes to antipsychotic class used for treatment and changes in optimal effective haloperidol dose: rather a change in the level of “background” knowledge of participants was most likely responsible. This study also found individual participant characteristic differences in those who did change treatment duration and minimum effective dose.
In conclusion, this study showed that the successful integration of international treatment recommendations into daily psychiatric practise could be facilitated by the use of appropriate educational seminars. Not all attendees benefit i.e. “learn”, but those needing to “learn” most do - i.e. those who need to change their prescribing habits most to meet internationally accepted guidelines. The peer exposure provided allows a format for informed discussion and the practise of evidence-based medicine. The judicious use of such seminars should result in better treatment options and outcomes for patients.attended evidence-based schizophrenia seminars presented by the Lundbeck Institute in Denmark. The objectives of the study were two-fold. Firstly, it set out to determine whether changes actually occurred in the post-seminar haloperidol prescribing behaviour of participants. This was done by analysing changes in choice of optimal haloperidol dose (both in acute treatment i.e. most effective dose and maintenance treatment i.e. minimum effective dose), selected duration of treatment (for first- and multi-episode schizophrenia patients) and drug-class used (conventional versus new generation antipsychotic). The study then investigated whether these changes (if they occurred) could be ascribed wholly or in part to the effect of schizophrenia seminar attendance, or whether other factors e.g. scientific progress over time in understanding schizophrenia and its treatment (“background” knowledge) and differences between participant datasets studied (only paired pre- and post-seminar data were used in this study) also played a role. Secondly, it attempted to identify factors predictive of seminar participants changing their haloperidol prescribing behaviour post-seminar i.e. what were the factors that predisposed some attendees to change their prescribing behaviour? This was done by analysing the effect that pre-seminar prescribing behaviour, participant nationality, patient caseload, work experience and workplace environment had on post-seminar behaviour.
Results show that changes did occur in post-seminar haloperidol prescribing behaviour, but that they were not always due to an effect of seminar attendance. Only the changes in the minimum effective haloperidol dose and duration of treatment for first- and multi-episode schizophrenia patients could validly be ascribed to the effects of schizophrenia seminar attendance. Furthermore, multivariate analysis of the factors relating to these changes found that a participant was most likely to change their selected minimum effective haloperidol dose to be more in line with internationally accepted standards if they i) selected above the target dose pre-seminar, ii) had a relatively low caseload comprised mainly of schizophrenia patients and iii) came from either Greece, Germany, Britain, Spain, Italy or some other Eastern European country. The single most important factor related to changes in duration of treatment was found to be pre-seminar behaviour: respondents below the recommended duration of treatment increased their duration of treatment significantly.
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