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P.3.c.030 Factors influencing therapeutic compliance in schizophrenia
S334
P.3.c. Psychotic disorders and antipsychotics − Antipsychotics (clinical)
groups showed slightly decrease of the SAS and BARS scores 24 hours after the first injection, and there were no significant differences between the two groups. No severe adverse events were noted and extrapyramidal symptoms (EPS) were only observed in 2 patients of the haloperidol plus lorazepam group (one with acute dystonia, one with akathisia). Conclusions: The present study suggests that IM olanzapine 10 mg and IM haloperidol 5 mg plus lorazepam 2 mg have comparable efficacy in acute treatment of schizophrenic patients with moderate to severe agitation. Both treatments are safe.
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Table: Comparisons of mean change in PANSS-EC, ACES, CGI, SAS, and BARS from baseline to 24 hours after the first injection Haloperidol 5mg + lorazepam 2mg pa
Olanzapine
PANSS-EC ACES CGI-S SAS BARS
Baseline 24 hrs
Difference Baseline 24 hrs
Difference
21.0±4.6 2.0±0.6 5.0±0.8 13.4±4.3 2.4±2.7
−9.1±5.5 1.2±0.9 −0.8±0.6 −0.4±1.3 −0.8±1.7
−8.1±3.1 1.3±1.0 −0.8±0.7 −0.6±2.8 −0.6±2.1
12.0±4.9 3.2±0.9 4.2±0.8 13.0±3.8 1.6±2.3
20.9±3.6 2.1±0.7 5.2±0.7 13.9±5.5 2.1±2.5
12.7±4.0 3.5±0.9 4.4±0.9 13.2±3.8 1.6±2.3
0.391 0.393 0.896 0.765 0.551
ap
value for comparing paired difference between two treatment groups, adjusting for centers.
P.3.c.030 Factors influencing therapeutic compliance in schizophrenia A. Tiugan1 ° , C. Tiugan2 1 University for Medicine and Pharmacy Craiova, Department of Psychiatry, Craiova, Romania; 2 Emergency Clinical Military Hospital Craiova, Department of Psychiatry, Craiova, Romania Introduction: The short term prognosis and especially the long term prognosis for the disorder is closely correlated with the medication addressability for obtaining the remission and especially maintaining the remission. The evolution of episodes and sometimes with incomplete remissions requires a long and at the same time uninterrupted treatment in schizophrenia, which can be achieved through a good therapeutic compliance. Objectives: Identification of non-compliance factors for targeting the therapeutic scheme towards increasing the chance for adherence to treatment. Method: A retrospective and longitudinal clinical study was developed over two groups (the first with twenty patients at their first psychotic episode and the second group with fifty patients diagnosed with schizophrenia, with an evolution of at least two years), monitoring the frequency and the reason for abandoning antipsychotic treatment, corroborated with clinical symptomatology. Results: Group I: 40% of the patients at the first episode abandoned the treatment in the first six months due to the lack of the consciousness of the disease and the presence of medicine side effects. Group II: Patients with an evolution of over two years: – On the change of the therapeutic scheme, 20% of the patients abandoned treatment due to side effects of the antipyschotic: weight increase from the treatment with Olanzapinum and Quetiapinum, emergence of extrapyramidal elements under the therapy with Risperidonum and Amisulpridum and the presence of gastrointestinal disorders (Aripiprazolum). – Discontinuation after six months of treatment was noticed in 20% of the patients without complete remission (irrespective of administered antipsychotic), in 40% of the patients with positive
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symptoms and aggressiveness, in 20% of the patients with side effects (weight increase, cardiac and metabolic modifications, extrapyramidal effects, sialorrhea, galactorrhea, dystonia), in 20% of the patients with frequent changes in the therapeutic scheme and in 20% of the patients with injectable antipsychotic. Discontinuation after two years of treatment appeared: through relapse 68%, side effects (especially weight increase 18%) and refusal of medication (in the absence of psychotic symptomatology) through “lack of need for treatment” 14%. Out of the patients maintaining antipsychotic treatment over two years, 62% included in their therapeutic scheme also a mood-stabilizing substance, while for 89% of the patients had a family member involved in the therapeutic management. Treatment discontinuation was significant (48%) for those presenting frequent interruptions from the therapeutic scheme in the first year of evolution. Conclusions: Therapeutic discontinuation appears frequently in the first episode of the disorder. Treatment non-compliance is closely correlated with the side effects of the antipsychotic substance administered, the lack of therapeutic responses and with the disorder’s clinical characteristics. Compliance increase is significantly related to the association in the therapeutic scheme of a mood-stabilizing substance and the presence of family support, especially when social and professional insertion is obtained.
P.3.c.031 Investigation of the applicability of a cybernetic model to clozapine-induced obsessive compulsive symptoms S.Y. Shin1 ° , S.H. Kim2 , N.Y. Lee1 , Y.M. Ahn2 , U.G. Kang2 , T. Youn1 , I.W. Chung1 , Y.S. Kim1 1 Dongguk University International Hospital, Department of psychiatry, Goyang, South-Korea; 2 Seoul National University Hospital, Department of psychiatry, Seoul, South-Korea Obsessive-compulsive symptom in schizophrenia appears to be relatively frequent, but onsets and patterns of obsessivecompulsive symptoms are varied very much for each patient. It can be assumed that the mechanism of every obsessive-compulsive symptom formation does not take the same path. As the use of atypical antipsychotics in schizophrenia increases recently, the newly appearing and worsening cases of obsessive–compulsive symptoms have been reported. But these cases show different onsets and patterns as well. It seems that the diversity is due to differences of mechanisms of atypical antipsychotics. Yet few hypothesis can make comprehensive explanation on this various aspects of obsessive–compulsive symptoms. It seems that clozapine induces or aggravates obsessivecompulsive symptoms more frequently than other atypical antipsychotics. Also clozapine is less effective in SSRI resistant obsessive-compulsive disorder than other atypical antipsychotics. We focused on pharmacological characteristics of clozapine which has multireceptor affinity. Clozapine effects multiple receptors at the same time. So the new equilibrium state can be formed in the brain. In this regard, the efficacy and tolerability of clozapine can be explained. In this study we explained the clozapine induced obsessive-compulsive symptoms using cybernetic model. Organisms compare reference level with perceptual level when there are changes. Error signals are generated when there are
P.3.c. Psychotic disorders and antipsychotics − Antipsychotics (clinical)
groups showed slightly decrease of the SAS and BARS scores 24 hours after the first injection, and there were no significant differences between the two groups. No severe adverse events were noted and extrapyramidal symptoms (EPS) were only observed in 2 patients of the haloperidol plus lorazepam group (one with acute dystonia, one with akathisia). Conclusions: The present study suggests that IM olanzapine 10 mg and IM haloperidol 5 mg plus lorazepam 2 mg have comparable efficacy in acute treatment of schizophrenic patients with moderate to severe agitation. Both treatments are safe.
–
–
Table: Comparisons of mean change in PANSS-EC, ACES, CGI, SAS, and BARS from baseline to 24 hours after the first injection Haloperidol 5mg + lorazepam 2mg pa
Olanzapine
PANSS-EC ACES CGI-S SAS BARS
Baseline 24 hrs
Difference Baseline 24 hrs
Difference
21.0±4.6 2.0±0.6 5.0±0.8 13.4±4.3 2.4±2.7
−9.1±5.5 1.2±0.9 −0.8±0.6 −0.4±1.3 −0.8±1.7
−8.1±3.1 1.3±1.0 −0.8±0.7 −0.6±2.8 −0.6±2.1
12.0±4.9 3.2±0.9 4.2±0.8 13.0±3.8 1.6±2.3
20.9±3.6 2.1±0.7 5.2±0.7 13.9±5.5 2.1±2.5
12.7±4.0 3.5±0.9 4.4±0.9 13.2±3.8 1.6±2.3
0.391 0.393 0.896 0.765 0.551
ap
value for comparing paired difference between two treatment groups, adjusting for centers.
P.3.c.030 Factors influencing therapeutic compliance in schizophrenia A. Tiugan1 ° , C. Tiugan2 1 University for Medicine and Pharmacy Craiova, Department of Psychiatry, Craiova, Romania; 2 Emergency Clinical Military Hospital Craiova, Department of Psychiatry, Craiova, Romania Introduction: The short term prognosis and especially the long term prognosis for the disorder is closely correlated with the medication addressability for obtaining the remission and especially maintaining the remission. The evolution of episodes and sometimes with incomplete remissions requires a long and at the same time uninterrupted treatment in schizophrenia, which can be achieved through a good therapeutic compliance. Objectives: Identification of non-compliance factors for targeting the therapeutic scheme towards increasing the chance for adherence to treatment. Method: A retrospective and longitudinal clinical study was developed over two groups (the first with twenty patients at their first psychotic episode and the second group with fifty patients diagnosed with schizophrenia, with an evolution of at least two years), monitoring the frequency and the reason for abandoning antipsychotic treatment, corroborated with clinical symptomatology. Results: Group I: 40% of the patients at the first episode abandoned the treatment in the first six months due to the lack of the consciousness of the disease and the presence of medicine side effects. Group II: Patients with an evolution of over two years: – On the change of the therapeutic scheme, 20% of the patients abandoned treatment due to side effects of the antipyschotic: weight increase from the treatment with Olanzapinum and Quetiapinum, emergence of extrapyramidal elements under the therapy with Risperidonum and Amisulpridum and the presence of gastrointestinal disorders (Aripiprazolum). – Discontinuation after six months of treatment was noticed in 20% of the patients without complete remission (irrespective of administered antipsychotic), in 40% of the patients with positive
– –
–
symptoms and aggressiveness, in 20% of the patients with side effects (weight increase, cardiac and metabolic modifications, extrapyramidal effects, sialorrhea, galactorrhea, dystonia), in 20% of the patients with frequent changes in the therapeutic scheme and in 20% of the patients with injectable antipsychotic. Discontinuation after two years of treatment appeared: through relapse 68%, side effects (especially weight increase 18%) and refusal of medication (in the absence of psychotic symptomatology) through “lack of need for treatment” 14%. Out of the patients maintaining antipsychotic treatment over two years, 62% included in their therapeutic scheme also a mood-stabilizing substance, while for 89% of the patients had a family member involved in the therapeutic management. Treatment discontinuation was significant (48%) for those presenting frequent interruptions from the therapeutic scheme in the first year of evolution. Conclusions: Therapeutic discontinuation appears frequently in the first episode of the disorder. Treatment non-compliance is closely correlated with the side effects of the antipsychotic substance administered, the lack of therapeutic responses and with the disorder’s clinical characteristics. Compliance increase is significantly related to the association in the therapeutic scheme of a mood-stabilizing substance and the presence of family support, especially when social and professional insertion is obtained.
P.3.c.031 Investigation of the applicability of a cybernetic model to clozapine-induced obsessive compulsive symptoms S.Y. Shin1 ° , S.H. Kim2 , N.Y. Lee1 , Y.M. Ahn2 , U.G. Kang2 , T. Youn1 , I.W. Chung1 , Y.S. Kim1 1 Dongguk University International Hospital, Department of psychiatry, Goyang, South-Korea; 2 Seoul National University Hospital, Department of psychiatry, Seoul, South-Korea Obsessive-compulsive symptom in schizophrenia appears to be relatively frequent, but onsets and patterns of obsessivecompulsive symptoms are varied very much for each patient. It can be assumed that the mechanism of every obsessive-compulsive symptom formation does not take the same path. As the use of atypical antipsychotics in schizophrenia increases recently, the newly appearing and worsening cases of obsessive–compulsive symptoms have been reported. But these cases show different onsets and patterns as well. It seems that the diversity is due to differences of mechanisms of atypical antipsychotics. Yet few hypothesis can make comprehensive explanation on this various aspects of obsessive–compulsive symptoms. It seems that clozapine induces or aggravates obsessivecompulsive symptoms more frequently than other atypical antipsychotics. Also clozapine is less effective in SSRI resistant obsessive-compulsive disorder than other atypical antipsychotics. We focused on pharmacological characteristics of clozapine which has multireceptor affinity. Clozapine effects multiple receptors at the same time. So the new equilibrium state can be formed in the brain. In this regard, the efficacy and tolerability of clozapine can be explained. In this study we explained the clozapine induced obsessive-compulsive symptoms using cybernetic model. Organisms compare reference level with perceptual level when there are changes. Error signals are generated when there are