Long-term Relapse Prevention Research Articles

Olanzapine

Olanzapine is an atypical antipsychotic that is approved in the US and Europe for the oral treatment of acute manic episodes in patients with bipolar I disorder, and for maintenance therapy to prevent recurrence in responders. Oral olanzapine is effective in the treatment of bipolar mania, both as single agent therapy and as adjunctive therapy in combination with lithium or valproate semisodium. In the treatment of acute episodes, olanzapine is superior to placebo and at least as effective as lithium, valproate semisodium, haloperidol and risperidone in reducing the symptoms of mania and inducing remission. Additional comparative studies are required to determine the efficacy of olanzapine relative to newer atypical antipsychotics, such as quetiapine, ziprasidone and aripiprazole. Olanzapine is also effective at delaying or preventing relapse during long-term maintenance therapy in treatment responders, and is currently the only atypical antipsychotic approved for this indication. Current evidence suggests that olanzapine may be more effective than lithium in preventing relapse into mania, but not relapse into depression or relapse overall. Olanzapine is generally well tolerated, and although it is associated with a higher incidence of weight gain than most atypical agents, it has a low incidence of extrapyramidal symptoms (EPS). Therefore, oral olanzapine is a useful first-line or adjunctive agent for both the acute treatment of manic episodes and the long-term prevention of relapse into manic, depressive or mixed episodes associated with bipolar I disorder.

P.6.070 Atomoxetine in the long-term prevention of relapse in ADHD

P.6.070 Atomoxetine in the long-term prevention of relapse in ADHD

Comparative effectiveness of antipsychotic drugs in schizophrenia

Chlorpromazine, which was discovered in 1952, has an exhaustively characterized efficacy/safety profile comprising serious limitations: effectiveness in the field failing to match efficacy in trials, residual symptoms in 50% of patients, a 20% relapse rate in compliant patients, and worrisome extrapyramidal side effects, including tardive dyskinesia in 5% per year. Second-generation "atypical" antipsychotics bypass these effects by having less affinity for the dopamine D(2) receptor and affinities for other neuroreceptors. Clozapine, the lead atypical antipsychotic, was followed in the mid 1990s by risperidone, olanzapine, and quetiapine, which now account for over half of new antipsychotic prescriptions in North America, The debate over their relative efficacy involves the potential well-being of millions of schizophrenics and billions of dollars. Atypical antipsychotics are considerably more expensive; evidence for their superiority is highly variable and often inadequate, largely confined to short-term regulatory studies. Their effects on long-term outcome (particularly negative symptoms), relapse prevention, social and vocational functioning, suicide prevention and quality of life, and family and caregiver burden are largely unknown. The National institute of Mental Health's Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project is a combined efficacy-effectiveness trial that aims to answer these questions in a broad range of patients with schizophrenia and Alzheimer's disease.

Treatment of cocaine dependence. Intoxication, withdrawal and prevention of relapse

The aim of this review article is to evaluate the treatment of cocaine-withdrawal, cocaine-intoxication and long-term relapse prevention of cocaine-addicts. Some 25% of police recognized first time drug users in Germany consume cocaine. However, there is an increasing number of cocaine-abusers and -addicts in the USA. The withdrawal of cocaine can be divided into three phases dominated mainly by psychiatric symptoms. Life-threatening condition can occur in cocaine-intoxication mainly in combination with other drug-use. A high risk of relapse is seen in follow-up trials of cocaine-addicts. Intensive craving, high cocaine- and substance-abuse is reported regularly in cocaine-addicts after detoxification therapy. Recommendations in the treatment of cocaine-intoxication, withdrawal and long-term relapse prevention are made. The use of antidepressives, anticonvulsants, dopaminergic and serotonergic medications as well as behavioural, psychoanalytical and combined therapies and their efficacy in clinical and trails is evaluated. A short review of new experimental therapies in the treatment of cocaine-dependence is shown.

Treating sex offenders using the sex addiction model

We treat sex offenders using the sex addiction model. Not all sex offenders are sex addicts, and vice versa. And the definition of a sexual offense is a legal, not a psychological, one. But much sexual addictive behavior is “offensive,” and the need for greater amounts of sexual experience may place the sex addict at increasingly greater risk of crossing the legal boundary. As a result, we believe that utilizing the sex addiction model in treating sex offense behavior strengthens other proven modalities by addressing core issues that fuel the unhealthy behavior. Additionally, we believe that long-term relapse prevention can better occur by improving patients' understanding of themselves and the etiology of their disorder, in addition to eliciting genuine changes in behavior, cognition, and emotion. Although we focus on behavioral change and relapse prevention, the addiction model addresses the issue of sexual compulsivity from a perspective that incorporates the spiritual component as a foundation for all other modalities. This integration of various therapeutic modalities and techniques better ensures positive long-term outcome.

Crack Cocaine Use in Rural Migrant Populations: Living Arrangements and Social Support

Correlates of crack cocaine use were studied among a targeted sample of migrant workers and their sexual partners (n = 571) in rural Southern Florida. Employment among men and recent drug-user treatment among men and women are positively related to crack use, as is involvement in crime and prostitution. Among women but not men, living with children is negatively related to crack use. Drug use and HIV prevention programs should intervene with individuals and their families and social groups. Migrant workers and their sexual partners also need effective drug-user treatment with long-term relapse prevention services.

Effects of a 2.5-mg Silver Acetate Lozenge on Initial and Long-Term Smoking Cessation

Background.Silver acetate over-the-counter products, such as gum, lozenge, and spray, produce an aversive metallic taste when combined with cigarette smoke. Hence, they hold promise of serving as an effective smoking deterrent, one that may be used on a self-help basis.Procedure.Five hundred adult smokers, male and female, were assigned randomly to one of two experimental conditions, 2.5-mg silver acetate lozenge and placebo lozenge. A double-blind study of the effects of a 2.5-mg silver acetate lozenge on initial (3 weeks) and long-term (12 months) smoking cessation was carried out.Results.About 90% of the subjects (n= 500) reported using the lozenge (silver acetate or placebo) for smoking cessation, and they used about five lozenges per day. Over 70% of the quitters (n= 70) reported using the lozenge on an as-needed basis for relapse prevention. The overall objectively verified quit rates for subjects assigned to the silver acetate and placebo conditions at Visit 3 (3 weeks) were 17% (n= 42) and 11% (n= 28), respectively, a difference which approached statistical significance (P= 0.071). When the analysis was restricted to subjects who used the product, a statistically significant difference (P< 0.05) in initial smoking cessation emerged (26%,n= 37 vs 16%,n= 23) for subjects assigned to the silver acetate and placebo conditions. At 12 months follow-up, 26% (n= 11) of initial quitters in the silver acetate condition and 32% (n= 9) of the quitters in the placebo condition were abstinent. This difference was not statistically significant.Conclusions.The study demonstrated modest efficacy for the effect of the 2.5-mg silver acetate lozenge on initial smoking cessation for the subset of subjects who used the product as recommended. We failed to demonstrate efficacy of the lozenge for long-term relapse prevention. Additional research on the efficacy of the 2.5-mg silver acetate lozenge and long-term abstinence in general appears warranted.

Long-term relapse prevention with clozapine in schizophrenia

Long-term relapse prevention with clozapine in schizophrenia

P-6-11 Long-term treatment and prevention of relapse of obsessive compulsive disorder with paroxetine

P-6-11 Long-term treatment and prevention of relapse of obsessive compulsive disorder with paroxetine

Paradigms of Recovery: Theoretical Implications for Relapse Prevention in Alcoholics

If planners keep the caveats of attention to long-term results, relapse prevention and employment of flexible, nondogmatic, forward-thinking personnel in mind, the move away from a myopic, pathogenic attitude toward addiction into a frame of mind which is challenged and ready to consider broad-based, long-term modalities designed to help people cope with life holistically appears to be the most positive and efficacious direction toward relapse prevention. Rather than to encourage alcoholics to surrender to forces beyond their control, the best approach may be strategies which reinforce the empowerment of people who feel spiritually empty, helpless and ineffectual.

Pharmacotherapeutic interventions for cocaine abuse. Matching patients to treatments.

Cocaine abuse treatment has begun to use a variety of adjunctive pharmacotherapies. These medications have been used for both acute crash symptoms and long-term prevention of relapse. A phasic model of recovery was integrated with a patient typology to formulate guidelines for using these rapidly evolving pharmacotherapies. The phases are crash, with-drawal, and extinction, and the patient typology includes psychiatric vulnerability and severity of cocaine abuse as contributors to the neuroadaptation that requires pharmacological amelioration. These guidelines address five issues: whom to treat, when to treat, what treatments are available, where to initiate and maintain treatment, and how to match patients to treatment options.