Oral Second-generation Antipsychotics Research Articles

Participation in Clinical Trials May Improve Care of Acute Schizophrenia Inpatients in a General Hospital

This report demonstrates parameters of quality of care and treatment outcome of acute schizophrenia patients who were involved as subjects in a clinical trial of two marketed widely used antipsychotics compared with their fellow patients who received routine clinical hospital care. Patients were newly admitted severely agitated schizophrenia patients who agreed to participate in a double-blind randomized trial of short-term (5 days) rate of improvement in response to two second-generation oral antipsychotics. Treatment outcomes as measured by the Clinical Global Impression and parameters of quality of care were compared with the general population of inpatients in the same county hospital. Of 145 patients screened, 109 patients did not meet study inclusion and exclusion criteria. It is of note that systematic diagnostic interview did not confirm the clinical diagnosis of schizophrenia in 17 patients (11.7%). Study patients had shorter length of stay (6.75 days vs 15.3 days of total psychiatric patients at the hospital during the study period), no physical restraints (vs 21.9%), no use of antipsychotics as chemical restraints (vs 19.8%), and less recidivism following the trial (28.1%) compared with prior to the trial (64.3%). Patients who participate in structured clinical research with well-delineated procedures, clinical outcome measures, and clear expectations, fared better than their fellow patients in the same non-research hospital wards. Application of some characteristics of clinical research to the diagnosis and treatment of clinical non-research patients may be considered.

Ethnic Comparisons of Antipsychotic Use in Schizophrenia

The aim of the present study was to compare ethnic groups for antipsychotic prescribing in schizophrenia over 4.5 years. All clinical files in three mental health services caring for outpatients in Auckland, New Zealand were reviewed at two time points (T1 =31 March 2000, T2 =31 October 2004). Data were collected (patient characteristics, diagnosis, antipsychotic treatment) and analysed at each time point. Adjustments were made for age and sex in the comparisons. After the first audit, feedback was provided to all three services. Differences in baseline prescribing were found between ethnic groups; rates of antipsychotic polypharmacy, second-generation antipsychotic (SGA) use, depot antipsychotic use, clozapine use and total antipsychotic dose. Overall five of the six prescribing outcome variables changed over the 4.5 years; only mean antipsychotic daily dose remained the same. Monotherapy rates increased in all ethnic groups with no difference found between them at T2 (85-86%). Similarly the prescribing variables of oral SGA use increased (83-87%), depots decreased (T2 =14-19%) and oral first-generation antipsychotics (FGAs) decreased (T2 =5-8%), all with no difference found between ethnic groups at T2. While clozapine use increased in all ethnic groups, a significant difference remained at T2; European, NZ Maori and Pacific all increased to 33-39%, but rates for Asian subjects increased only to 20%. The difference in mean daily antipsychotic dose between ethnic groups (122 mg day(-1) chlorpromazine equivalent (CPZe) at T1; 86 mg day(-1) CPZe at T2) reached statistical significance at both time points but overall the average dose (total mg day(-1)) for each group was within the usual clinical range. Adjustment for age and sex did not change the significance of any of the comparisons between ethnic groups. Most baseline differences in antipsychotic prescribing between ethnic groups resolved over time, with equal access for patients to recommended best practice with antipsychotic treatment in schizophrenia. Further work is required to look at differences in access to clozapine for Asian people.

Rehospitalisierungsfreie Intervalle bei schizophrenen Patienten unter oralen Atypika versus herkömmlichen Depotneuroleptika

The reduction of the frequency of rehospitalisation is important for improving the outcomes for patients with schizophrenia. This study compares the rate of rehospitalisation between patients with antipsychotics in depot-form (n = 77) and oral second-generation antipsychotics (SGA) (n = 156). Patients with antipsychotics in depot-form had lower risk of rehospitalisation than with SGAs in oral-form after 24 months (p = 0.027) and 36 months (p = 0.018) (Kaplan-Meyer survival analysis, Log-Rank). Long intervals between two hospitalisations were found for flupentixol depot and clozapine. Antipsychotics in depot-form require and active and close outpatient treatment, which may account for long intervals between hospitalisation improved outcomes for patients with schizophrenia.