Continuous versus targeted medication in schizophrenic outpatients: outcome results

Article Abstract:

Schizophrenics are primarily treated with antipsychotic drugs, which are effective in reducing symptoms and preventing relapses. However, long-term use of these drugs has been found to lead to adverse side effects, including severe movement disorders. Alterations in treatment protocols have been suggested to prevent possible adverse effects of these drugs. Two alternative protocols would substantially decrease the amount of overall drug exposure to the patient. One approach is a continuous low dose which would be increased only during exacerbations; the other is an intermittent dose given only during periods of symptom aggravation. Since the psychotic symptoms of schizophrenia are often episodic, these approaches seem justified. The episodes are usually preceded by symptom and behavioral patterns which predict the need to begin intervention. Research has shown this approach to be successful, and a review of these studies is included. This study compared the drug effects of intermittent and continuous medication regimens in the context of increased psychosocial therapy. The psychosocial therapy included weekly individual therapy, and forms of family therapy, along with education on the nature and treatment of schizophrenia. The continuous medication study group (59 patients) received a low dose until typical preceding symptoms occurred, at which time their dose was raised and later lowered after restabilization. The intermittent group (57 patients) only received drugs during the symptomatic episodes and restabilization periods. These two groups were closely followed over a two-year period; 81 percent of the continuous group and 49 percent of the intermittent group completed the two-year study course. A substantial reduction in drug dose level was achieved in both groups, even when heavy medication during hospitalizations were considered. The continuous-medication group had fewer exacerbations of symptoms and hospitalizations, as expected, but this difference was not significant. The continuous-medication group had a higher level of functioning than the intermediate group, but overall, neither group improved substantially on this rating by the end of the two-year period. The results of this study supports the use of methods which lower the overall drug exposure, and subsequently decrease the risk of developing adverse effects. This protocol would be especially appropriate for patients who have been selected as good candidates for medication reduction. (Consumer Summary produced by Reliance Medical Information, Inc.)

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A longitudinal assessment of haloperidol doses and serum concentrations in Asian and Caucasian schizophrenic patients

Article Abstract:

Previous studies have suggested that there is a difference in the tolerance of anti-psychotic drugs between Asians and Caucasians. Two groups of male schizophrenics, one consisting of 16 Asians, and the other of 14 Caucasians, were monitored over a three-month period to assess their reactions to varying dosages of haloperidol, a common therapeutic neuroleptic (anti-psychotic medication). The first phase of the study included treatment with adjusted fixed dosages to all of the subjects. The second phase consisted of dosages which were clinically varied as needed. During both of these periods, measurements were made in all the subjects of concentrations of the drug in the blood and side effects. The Asian group showed slightly higher mean serum concentrations and exhibited a much higher rate of extrapyramidal symptoms during the fixed dosage trial. Extrapyramidal symptoms are common side effects of neuroleptics which typically include involuntary movement or twitching, a change in muscle tone, and abnormal posture. When the second phase of the variable dosage was assessed, the Asian group required less medication and exhibited fewer side effects, and the concentration of haloperidol in the blood was lower. These results support the prior observation that, as a group, Asians are more sensitive to therapeutic neuroleptics than Caucasians. The implication is that Asians generally require lower dosages of neuroleptics than Caucasians, a factor which should be considered when clinical treatment is administered.

Research, Complications and side effects, Health, Health and race, Ethnic groups

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Ethnicity and family involvement in the treatment of schizophrenic patients

Article Abstract:

The intergenerational sense of responsibility and family participation in the treatment of illness is reportedly greater in Asian families than in Caucasian families. Asians families more often accompany family members to treatment centers and they are more active in the search for treatment than Caucasian families. Though the existence of such cross-cultural differences is not disputed in the literature, no supportive empirical studies have been reported. A longitudinal, cross-cultural investigation was designed to document differences in family participation in the treatment of a family member with a psychiatric disorder. Twenty-six Asian schizophrenic patients and their families and 26 Caucasian schizophrenic patients and their families were followed for three months. Standard treatment was offered to the patients and the involvement of family members in the treatment was documented. As expected, Asian families were markedly more involved in the care of their family member than Caucasian families. Psychiatric treatment staff should include Asian families in all facets of patient care whenever possible and also attempt to foster greater involvement by Caucasian family members. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Family, Psychotherapy patients, Family health

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