Lessons From Each Drug Trial

American Journal of Psychiatry (Impact Factor: 12.3). 04/2007; 164(3):375-6. DOI: 10.1176/appi.ajp.164.3.375
Source: PubMed
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    ABSTRACT: Mr. B is a 34-year-old man with a 13-year history of schizophrenia. His early treat- ment consisted of brief trials of first-gen- eration antipsychotics, which he refused to take for any significant period of time. He was then started on risperidone at an average of 5 mg/day. Within a few months, he and his mother noticed that he had upper and lower extremity tremor and profound motor restlessness, espe- cially of the legs. These symptoms wors- ened until Mr. B was taken off risperidone and started on olanzapine, after which the tremor resolved, but the restlessness persisted. Mr. B's discomfort was so se- vere that he was unable to sit through a 15-minute medication management ap- pointment without getting up and pacing the room. His mother noted that the rest- lessness lasted throughout the day, re- lenting only when he slept. Mr. B stated that he could not stay still for more than a few minutes at a time and that he had an irresistible urge to move, which led him to pace the house and neighborhood until the soles of his feet were bleeding. Mr. B's mother also reported that when the restlessness was at its worst, he was extremely irritable, easily agitated, and sometimes violent.
    American Journal of Psychiatry 12/2007; 164(11):1648-54. DOI:10.1176/appi.ajp.2007.07071150 · 12.30 Impact Factor
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    ABSTRACT: In this commentary, we review recent research suggesting that (a) second-generation antipsychotics (SGAs) may be no more effective than first-generation antipsychotics (FGAs), (b) the reduced risk of EPS and tardive dyskinesia with SGAs is more weakly supported by the research literature than has been appreciated, and (c) benefits may be offset by greater metabolic risks of some SGAs and their substantially greater cost. Bearing in mind, as well, that risperidone, currently the least expensive SGA, will soon be available as an even less expensive generic drug, we propose a new algorithm for maintenance antipsychotic therapy. We further outline a cautious implementation procedure that relies on standardized documentation and feedback, without a restrictive formulary that would limit physician choice. The algorithm outlined here and the process for its implementation are intended as a stimulus for discussion of potential policy responses, not as a finalized proposition.
    Schizophrenia Bulletin 04/2008; 34(2):375-80. DOI:10.1093/schbul/sbm089 · 8.45 Impact Factor
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    ABSTRACT: This naturalistic study aims to compare discontinuation rates for low-dose first-generation versus second-generation antipsychotics in first-episode psychotic patients. The prescription of antipsychotic medication in 301 consecutively admitted patients with first-episode psychosis from four catchment areas is described. For the first year of inclusion a first-generation antipsychotic in low dose was recommended as the first medication. From the second year a second-generation antipsychotic was recommended as first choice. Switching was allowed when any drug was judged to be ineffective or to have serious side-effects. Switching during the first 2 years after inclusion is described. Switching from a low-dose first-generation antipsychotic was more frequent than from a second-generation antipsychotic (90.7 vs. 58.4%). Lack of therapeutic effect and side-effects were the more frequently recorded reasons for changing in the first-generation group. Akathisia, parkinsonism, dyskinesias, dystonia and dysphoria were more often reported in patients on first-generation drugs. Weight gain and sedation were more often reported in patients on second-generation drugs. The findings suggest a better adherence to and tolerability for second-generation antipsychotics than for low-dose first-generation antipsychotics in first-episode psychosis.
    Early Intervention in Psychiatry 02/2009; 3(1):58-65. DOI:10.1111/j.1751-7893.2008.00103.x · 1.95 Impact Factor
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