Volume 7, Issue 1, March 2005
The complexity of the acute and maintenance pharmacological interventions is a very important problem in the management of the schizophrenic patients. Antipsychotics are used as target therapy while anxiolytics, hypnotics, antidepressants, mood stabilizers can be given as adjunctive treatment. We have evidence based, experimental, anecdotic knowledge about the therapy of schizophrenia but we do not know the facts of the practice. The aim of my study was to evaluate the trends in the prescription of psychotropic drugs for schizophrenic outpatients in Hungary. Method. A questionnaire has been constructed and been sent to the psychiatrists. The study was blind to the investigator because nor the psychiatrists neither the patients were identified. The patients turned to psychiatrists from 9th to 20th June 2003 were included in the cross-sectional study. Results. 147 questionnaires were evaluated. 30% of the patients take only one, 35% two and 23% three, 12% four or more kinds of psychotropic drugs simultaneously. Only 6 patients are not given any antipsychotic drugs. About 30% takes some kind of typical (first generation) while 80% atypical (new generation) form and about 15% is on antipsychotic combination therapy. The pro portion of depot is 26 %. The most frequently used antipsychotics are olanzapine, flupenthixole, clozapine and risperidone. The ranges of the doses show an optimal use. 45,6% of the patients is on anxiolytic, 19% on any kind of antidepressant and 11% on hypnotic drug and only 4,1% on any kind of mood stabilizers. The data of duration of therapy show that the rate of switch an antipsychotic to another for one year before the index time is low (30%) but about 8,8% of the patients are on the same antidepressant and 21,1% on the same anxiolytic drug in that period. There are not gender differences in the therapy. Conclusion. The results show the current trends of pharmacological treatment of schizophrenic outpatients in Hungary. The data of the study are comparable with international trends, professional expectation and the new evaluations in the future.
KEYWORDS: schizophrenia, prescription, crosssectional study, psychopharmacological trend
There are three various approaches in the pharmacological treatment of posttraumatic stress disorder (PTSD) among the published data. The most frequently implemented approach is to treat patients suffering from the diagnosis of PTSD. Both short-term acute and long-term relapse prevention treatments represent a curative paradigm: with an intention to diminish the symptoms associated with the disorder. Data about efficacy of monoamine oxidase inhibitors and selective serotonin reuptake inhibitors (SSRIs) in the treatment of PTSD are heterogeneous. Data are relatively consistent with regards of efficacy of SSRIs in the treatment of civilian, predominately female population, regardless of the type of trauma: interpersonal or non-interpersonal trauma. Placebo controlled trial data in the treatment of combat-related PTSD are inconclusive or negative. Three recently published studies provide new approaches to the treatment of male patients, suffering from combat-related PTSD. A relatively young, recently traumatized male, combat-related population showed significant improvement for fluoxetine compared to placebo. An adjuvant 5HT2 antagonist profile may improve the SSRI effect in the treatment of PTSD: nefazodone was significantly superior compared to placebo in the treatment of combat-related PTSD, and risperidone treatment add-on to antidepressants showed significant benefits compared to antidepressant monotherapy in the treatment of combat-related PTSD. The goal of sedative paradigm is to minimize the immediate consequences of the traumatic stress, decrease the fear, anxiety and sleeplessness. Data published about benzodiazepines failed to show effectiveness in the acute management of post-traumatic mental consequences. The intention of the third treatment paradigm is characterized by the secondary prevention of PTSD. Benzodiazepines administered shortly after the traumatic event, failed to prevent the mental consequences of traumatic stress. Two small trials with propranolol administration after the trauma have been shown some benefits compared to placebo or no treatment. PTSD represents a complex disregulation of numerous neurotransmitters and neuromodulators, therefore the complex pharmacological treatment has to consider approaches beyond the current treatment regimens characterized by modulation of monoamine neurotransmission.
KEYWORDS: posttraumatic stress disorder, sedative paradigm, curative paradigm, secondary prevention
Schizophrenia is a major chronic psychiatric disorder associated with significant impairment in psychosocial functioning and reduced quality of life. The major goals of current pharmacotherapy for schizophrenia are to achieve continuous relief from psychotic symptoms, to reduce relapse rates, and to provide maximal patient functioning and improved quality of life. To attain these goals, treatment needs to be effective, safe, and well tolerated. It is now generally accepted that the use of second generation or atypical antipsychotics for schizophrenia represents and advance over conventional antipsychotics However, therapeutic compliance continues to be a major problems of the maintenance treatment. The long-acting conventional injectable antipsychotics might increase compliance, but they have become unpopular, largely because of the associated adverse events – akathisia, akinesia, and weight gain. Long-acting risperidone is the first atypical antipsychotic to be available in a long-acting formulation, which combines the benefits of risperidone with the advantages of a long-acting injection. It is dosed at 25-50 mg every 2 weeks. Available data on long acting atypical risperidone suggest that it is safe, efficacious and well tolerated. Long acting risperidone initiated during inpatient and outpatient treatment may be an important strategy in improving long-term outcomes among patients with schizophrenia. This article provides practical advice to physicians on he characteristics of patients who would benefit from treatment with long acting atypical antipsychotic agent and offers suggestions on how to initiate treatment.
KEYWORDS: long acting risperidone, compliance, relapse rate, schizophrenia
Combined Effect Of Promoter Polymorphisms In The Dopamine D4 Receptor And The Serotonin Transporter Genes In Heroin Dependence
Ágnes Szilágyi, Krisztina Boór and collegues
Dopamine D4 receptor (DRD4) and serotonin transporter (SERT) gene polymorphisms were studied, as possible genetic risk factors for substance dependence. The case-control study involved a large cohort (n=362) of healthy Caucasian population, and an initial sample of 73 substance dependent patients (including a subgroup of 53 heroin dependents). Improved methods were applied for genotype detection of the DRD4 polymorphisms (exon 3 48 bp VNTR; -521 C/T SNP and 120 bp duplication in the 5’ flanking region) and the SERT gene polymorphisms (5-hydroxytriptamin transporter linked polymorphic region [5-HTTLPR] in the 5’ flanking region and the intron 2 VNTR [STin2]). Association between the -521 C/T SNP of the DRD4 promoter region and substance dependence was significant in the subgroup of heroin dependents (p=0.044). The other analyzed polymorphisms did not show any significant association, but an interaction between -521 C/T SNP of DRD4 and the 5-HTTLPR polymorphisms was observed. Association between the -521 CC vs. CT or TT genotypes and heroin dependence was enhanced in the presence of short (s or 14-repeat) 5-HTTLPR allele (p0.01). The odds ratio of 2.14 observed for the -521 CC genotype increased to 4.82 in double homozygotes of -521 CC and 5-HTTLPR ss, emphasizing the importance of combined analysis of polymorphisms in the dopaminergic and serotonergic systems in heroin dependence. However, due to the limited size of our sample these results should be interpreted with caution.
KEYWORDS: substance dependence, association study, DRD4, SERT, 5-HTTLPR
Clinical expectations are high toward atypical, second generation antipsychotics (SGAs). Controlled clinical trials supporting the superiority of SGAs over traditional agents are scarce. Meta-analysis of existing data may come for the rescue but that kind of method has its limitations. One of the most meticulous approaches (Davis et al. 2003) reached the conclusion that some, but not all, SGAs are more efficacious than traditional ones. Within the group of distinguished drugs, clozapine and amisulpride have the highest efficacy. Present paper critically overviews the study of the Davis group. Based on in vivo D2 receptor binding data of the new SGAs and the usual post marketing changes of clinical dosing, it is expected that some of the currently and most recently marketed SGAs may show similar superiority.
KEYWORDS: amisulpride, antipsychotic drugs, clozapine, controlled clinical trials, dopamine D2 receptors, haloperidol, schizophrenia
The curability of schizophrenia is not clear, but in this case report we have a paranoid schizophrenic patient with clozapine treatment, who become symptom free during three decade of clozapine. During this time he had a very successful career and have to discusse these long term maintenance antipsychotic treatment in schizophrenia. From his mothers-relative got schizophrenic genes and started the patient´s psychosis at age 27, after two therapeutic-resistance years he got clozapine and become symptom free. His complience is perfect, clozapine has no side effects.
KEYWORDS: schizophrenia, family heredity, clozapine, compliance