Psychotic Side Effects Research Articles

Vigabatrin: Wirksamkeit und Verträglichkeit bei Epilepsien im Erwachsenenalter

The experience with vigabatrin as anticonvulsant add on-therapy in adults with previously pharmacotherapy-resistant seizures is reviewed on the basis of several single-blind and ten double-blind, placebo-controlled studies. Evaluation of efficacy showed an at least 50 % reduction of seizure frequency in every second patient. Longterm follow up studies demonstrated a possible loss of efficacy over time but exact data are still missing. As anticipated, the achievement of seizure-freedom in patients with so far therapy resistant epilepsies is possible in only few patients, but in several patients improvement of duration and intensity of seizures is obtained beside reduction of seizure frequency. The presently recommended standard dose is two to three g/day in a b. i. d regimen. The main side effect is sedation in about 20 % of the patients which is less often observed with slowly increasing dosages starting with 500 mg/day instead of 2 g/day initially. Possibly, psychotic side effects are observed more often with vigabatrin than with other anticonvulsants, but they are reversible after discontinuation of the drug like all other side effects. Measurements of serum level and other laboratory studies are less important as compared with other antiepileptic drugs.

Need for community care among psychotic outpatients

Psychiatric teams examined a representative sample of 177 psychotic patients in community care. The patients' need for care was assessed using a standardized method. The need for alternative, noninstitutional forms of care (i.e. day and residential services) was greater than the actual use of these services. The same was true of the need for support in social activities, for occupational therapy, training in domestic skills, counselling for relatives and psychotherapy. Unmet needs for care were commonest among patients who were young, who drank heavily, and who suffered from many psychotic symptoms and drug side effects. Outpatient care based primarily on visits to the community mental health centres did not provide adequate services for the most disabled patients. It is concluded that decrease of hospital care has brought a growing need for psychiatric day and residential services among outpatients suffering from psychotic disorders.