Efficacy In Schizophrenia Research Articles

Quetiapine – efficacy in different domains

Conventional treatment paradigms for schizophrenia have typically focused on reducing positive symptomatology; however, it is increasingly apparent that negative and cognitive symptoms are also important treatment targets. Cognitive function, in particular, is known to affect multiple outcome domains, including performance of basic daily activities, and social and occupational functioning. While traditional antipsychotics have little, or even a detrimental, effect on neurocognitive impairment in patients with schizophrenia, available data suggest that cognitive function may be improved during treatment with atypical antipsychotics. Quetiapine is a novel atypical antipsychotic with proven efficacy in schizophrenia across all domains. Results of well-controlled, double-blind, randomised studies show quetiapine to significantly improve cognitive function compared with treatment with haloperidol. Quetiapine has also been shown to be effective and well tolerated in patients particularly vulnerable to the extrapyramidal side effects (EPS) associated with conventional antipsychotics, making it well suited for use as first-line therapy.

Efficacy of mirtazapine add on therapy to haloperidol in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study

The negative symptoms of schizophrenia remain a major clinical challenge. Mirtazapine is an antidepressant with antagonist properties at 5-HT2A, 5-HT3 and alpha 2 receptors as well as indirect 5-HT1a agonist effects. Many of these pharmacological actions have clinical or preclinical evidence of efficacy in schizophrenia. This study was a 6-week randomized placebo-controlled trial of mirtzepine or placebo add on to haloperidol 5 mg in the treatment of 30 patients with DSM-IV schizophrenia. The primary finding of the trial was a 42% reduction in Positive and Negative Syndrome Scale (PANSS) negative symptom scores in the mirtazapine group compared to placebo at the end of 6 weeks (mirtazapine 13.9, SD 1.56; placebo 23.9, SD 1.56; P = 0.000, F = 20.31, d.f. = 1). The PANNS total scores, Clinical Global Impression severity and improvement scales in addition showed superiority of mirtazapine over placebo. There was no difference between the groups on the Hamilton depression scale at endpoint, suggesting that the improvement in negative symptoms was not an artifact of mood improvement. These results suggest a potential role for mirtazapine in the negative symptoms of schizophrenia.

The changes of biological markers and treatment efficacy in schizophrenia

1. In a group of schizophrenic patients, the effect and selected parameters of biological markers were evaluated during the index hospitalisation in the acute phase of schizophrenia (n = 30) and then after one year of ambulatory treatment. 2. During the acute treatment, a significant drop in symptomatology was recorded in average; an analogical tendency was observed further on, too. Apart from that, a significant change was observed in 5/41 parameters being monitored (the pair t-test):I) decrease in the total NES score, II) decrease in the sensorial integration subscale NES score, III) increase in psychomotor speed, IV) decrease in auditory reaction time, V) increase in basal cortisol. 3. In the comparison of the successfully (severity of illness after one year = 1, 2) and unsuccessfully (severity of illness after one year ≥3) treated patients in the beginning of treatment in the acute phase, the unsuccessful group had a significantly higher score of negative symptomatology, and by the end of the acute treatment, again, a significantly higher score of negative symptomatology, a higher total PANSS score and a greater severity of illness. 4. In the acute phase, the successful group had a significantly better score in individual items of the Contemporary Memory Scale and a significantly worse performance and goal-aimed concentration in the Bourdon test than the unsuccessfully treated one; apart from that, it had a significantly higher cortisol leel after dexamethasone, which was also reflected in the lower percentage rate of dexamethasone nonsuppression. 5. In the course of the year, a drop in the total NES score for the individual subscales occurred; a significant drop was observed in the sensory integration subscale. The worse concentration items improved significantly in the successful group in contrast to the unsuccessful group, where they showed a downgrade tendency. Changes in Contemporary Memory Scale were negligible and mostly below statistical significance. Apart from that, a drop in basal cortisolemia occurred in the successful group and an increase in cortisolemia after administering dexamethasone was registered in the unsuccessful group. 6. The more successful group had a significantly lower NES score, a significantly better visual reaction time and a smaller forgetting item (in percentiles) after the one-year period.

Safety profile of amisulpride in short- and long-term use

To assess the safety of the new atypical antipsychotic drug, amisulpride, in short- and long-term use. Studies comparing the safety of amisulpride with that of haloperidol and risperidone, respectively, are reviewed. Safety was monitored by open adverse event reporting, the Simpson-Angus Scale, the Barnes Akathisia Scale and the Abnormal Involuntary Movement scale. In short- and long-term studies, amisulpride induced significantly less EPS and akathisia than haloperidol. Safety ratings were similar to risperidone in short-term studies. In studies of chronic schizophrenia with predominant negative symptoms, amisulpride was similar to placebo. Endocrine effects were similar in amisulpride-, haloperidol- and risperidone-treated patients. Weight gain with amisulpride was significantly less than risperidone in a short-term study. No clinically important effects on haematological, hepatic or cardiac function were recorded. Data obtained in short- and long-term studies have been confirmed in extensive post-marketing surveillance data. Amisulpride has a broad spectrum of efficacy in schizophrenia without introducing the iatrogenic consequences associated with older therapies.

Amisulpride: a review of its efficacyin schizophrenia

To assess the efficacy of the new atypical antipsychotic drug, amisulpride. Studies comparing the efficacy of amisulpride with that of haloperidol and risperidone, respectively, are reviewed. Outcome measures were Clinical Global Impression, Brief Psychiatric Rating Scale (BPRS), and Positive And Negative Symptom Scale (PANSS) scores. Amisulpride was at least as effective as haloperidol and risperidone in the improvement of positive symptoms, and significantly more efficacious than haloperidol in reducing PANSS negative subscores (P=0.038) in patients with acute exacerbations. Amisulpride demonstrated a greater improvement in BPRS total scores (P<0.05) and PANSS negative subscores (P=0.0001) than haloperidol after 12 months of treatment in chronic schizophrenic patients with acute exacerbations. Amisulpride can thus be considered for use as first-line treatment of acute and chronic schizophrenia.

Clozapine Response In Chronic Schizophrenia And Brain Morphology On MRI: A Preliminary Report

Clozapine is a dibenzodiazepine atypical antipsychotic agent with demonstrated efficacy in treatment resistant and treatment intolerant schizophrenic populations (Kane 1988;Pickar 1992). Previous reports suggest clozapine's efficacy in schizophrenia may be related to morphologic abnormalities in lateral frontal and prefrontal cortices as measured on CT (Friedman 1991;Honer 1993) and MRI (Breier 1993). To examine this issue further, 18 chronic schizophrenic (DSM-III-R) patients (mean age 27 years, 89% male) who received standardized treatment with clozapine (mean duration of treatment = 30 months ± 19.43), underwent assessments for psychopathology (BPRS, CGI, SANS) and brain morphology with magnetic resonance imaging. MRIs were acquired using a gradient echo pulse sequence (3D flash) on a Siemens-Magneton (1.0 tesla) system. Images were analyzed under blind conditions by trained personnel using quantitative (total brain volume, interhemispheric fissure volume) and qualitative (evaluation of sulcal prominence, cerebral cortex, lateral ventricles, third ventricle, medial temporal lobe structures) measures. Data analyses examined the relationship between brain morphologic variables and measures of psychopathology at baseline and during clozapine treatment. Preliminary analyses to date have found no significant associations between the specific morphologic variables described above and treatment outcome. Mean severity of psychopathology at baseline was associated with increased interhemispheric fissure volume (r = 0.54,p = 0.02), due to positive symptom factors on the BPRS. These results mainly reflecting replicate previous findings of abnormal brain morphology being associated with poorer response to clozapine. Reasons may include differences in patient samples and the limited number of patients studied. This issue will be reexamined in the context of a larger patient sample as data become available.

Benzodiazepines in the treatment of schizophrenia: a review and reappraisal

Benzodiazepines, either alone or added to neuroleptics, have been studied extensively as treatments for schizophrenia, but no consensus regarding their efficacy has been reached. The authors review the double-blind trials in the literature and relate the findings to the neurobiology of benzodiazepine actions. The clinical review included all double-blind studies through 1989 that could be identified by means of Index Medicus and computer-assisted searches and by the cross-referencing of articles. The findings from the 14 studies of benzodiazepines used alone and the 16 studies of adjunctive therapy are presented separately. The studies reviewed suggest that 1) response is highly variable, and about one-third to one-half of patients improve; 2) benzodiazepines are potentially most useful as adjuncts to neuroleptics in the acute management of psychotic agitation, although actual antipsychotic effects have also been observed in some patients; 3) relatively higher doses of benzodiazepines may be associated with better response; and 4) therapeutic effects, when seen, develop rapidly but diminish after several weeks in some patients. The authors explore the neurobiological bases of benzodiazepine action, which presumably underlie their efficacy in schizophrenia and may help explain the variability of response. Future research on benzodiazepines in the treatment of schizophrenia should focus on features that predict response, the relation of dopamine or other neurotransmitter systems to therapeutic effects, the schizophrenic symptoms most amenable to benzodiazepine treatment, changes in neuroleptic dose during benzodiazepine augmentation, the role of benzodiazepines in maintenance therapy, and the optimal characteristics of benzodiazepine treatment.

No correlation between neuroleptic-induced increase of beta-endorphin serum level and therapeutic efficacy in schizophrenia.

In 23 acute, unmedicated, schizophrenic patients, psychotic behaviour and beta-endorphin serum level were measured before and during four weeks of neuroleptic therapy. Prior to drug treatment, beta-endorphin level of all patients was within the normal range. Neuroleptic therapy induced marked elevations of beta-endorphin in eight subjects; statistical analysis revealed a slight but significant increase for the whole group. This endocrine effect was not correlated with therapeutic efficacy of neuroleptic treatment.

The Experience of Efficacy in Schizophrenia

Back to table of contents Previous article Next article AbstractsNo AccessThe Experience of Efficacy in SchizophreniaFrederick S. Mendelsohn, M.D.Frederick S. MendelsohnNew, York, N.Y.Search for more papers by this author, M.D.Published Online:30 Apr 2018https://doi.org/10.1176/appi.psychotherapy.1966.20.3.543AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "The Experience of Efficacy in Schizophrenia." American Journal of Psychotherapy, 20(3), pp. 543–544 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - APT - American Journal of Psychotherapy $35.00 Add to cart PPV Articles - APT - American Journal of Psychotherapy Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 20Issue 3 1966, pp. 387–560Pages 543-544 Metrics PDF download History Published online 30 April 2018 Published in print 1 July 1966

THE EXPERIENCE OF EFFICACY IN SCHIZOPHRENIA.

THE EXPERIENCE OF EFFICACY IN SCHIZOPHRENIA.