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C.02.03 Targeting cognitive and neuropsychiatric symptoms in early dementia
C.03. Transforming the long-term management of schizophrenia C.02.03 Targeting cognitive and neuropsychiatric symptoms in early dementia
C.03. Transforming the long-term management of schizophrenia
S. Kasper1 ° 1 Medical University of Vienna, Department of Biological Psychiatry and Psychotherapy, Vienna, Austria
C.03.01 Treatment options in schizophrenia
Both cognitive and non-cognitive symptoms cause burden for patients with mild cognitive impairment (MCI) and early dementia. Most dementia patients are affected by neuropsychiatric symptoms (NPS), such as apathy, depression, anxiety, or irritability. In MCI at least one NPS can be observed in almost half of the patients. Therefore treatment options have to be evaluated for their potential to alleviate these symptom clusters. Amnestic MCI: A recent meta-analysis suggests moderate beneficial effects of cognitive training on overall cognition and self-ratings. Recommendations for Mediterranean diet or polyunsaturated fatty acids (PUFAs) can be derived from epidemiological data, but evidence from intervention trials is still incomplete. Only marginal symptomatic improvements have been observed with cholinesterase inhibitors. Furthermore, a study on Ginkgo biloba leaf extract EGb 761® (240 mg/day) demonstrated improved attention, memory and quality of life. MCI with NPS: Interventions effective on cognition in MCI have been reported to alleviate NPS, too. Positive effects on mood have been reported for cognitive training and supplementation with PUFAs. A placebo-controlled clinical trial with EGb 761® in this specific population has just been completed. Dementia with NPS: Treatment of NPS in early dementia comprises elimination of modifiable causal factors, psychosocial interventions, and drugs. The GINDEM-NP [1], GOTADAY [2] and GOT-IT [3] studies showed that 240 mg/day EGb 761® improved cognitive function, NPS, activities of daily living and quality of life vs. placebo. Effects were comparable in dementia of the Alzheimer-type and vascular dementia. Cognitive improvement correlated with severity of baseline NPS in these trials. References [1] Napryeyenko, O., Borzenko, I., GINDEM-NP Study Group. 2007. Ginkgo biloba spezial extract in dementia with neuropsychiatric features. A randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung Drug Res 57, 4−11. [2] Ihl, R., Tribanek, M., Bachinskaya, N., for the GOTADAY Study Group. Efficacy and Tolerability of a Once Daily Formulation of Ginkgo biloba Extract EGb 761® in Alzheimer’s Disease and Vascular Dementia: Results from a Randomised Controlled Trial. Pharmacopsychiatry 26, 1186–1194. [3] Herrschaft, H., Nacub, A., Likhachevc, S., Sholomovd, I., Hoerr, R., Schlaefke, S., on behalf of the GOT-IT! Study Group. Ginkgo biloba Extract EGb 761® in Dementia with Neuropsychiatric Features: A Randomised, Placebo-Controlled Trial to Confirm the Efficacy and Safety of a Daily Dose of 240 mg. Journal of Psychiatric Research, in press. Disclosure statement: Dr. Kasper has received grant/research support from Bristol Myers-Squibb, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Sepracor and Servier has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Lundbeck, Merck Sharp and Dome (MSD), Novartis, Organon, Pfizer, Schwabe, Sepracor, and Servier and has served on speakers’ bureaus for Angelini, AstraZeneca, Bristol Myers-Squibb, Eli Lilly, Janssen, Lundbeck, Pfizer, Pierre Fabre, Schwabe, Sepracor, and Servier.
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M. Schmauss1 ° 1 Bezirkskrankenhaus Augsburg, Department of Psychiatry, Augsburg, Germany Medication adherence is influenced by disease-related factors (insight, severity of illness, and length of illness), and medicationrelated factors (efficacy, safety, and tolerability). Evidence shows that non-adherence to medication is associated with increased relapse and rehospitalization rates, as well as poor patient outcomes. Therefore, the consequences of non-adherence may have a profound impact on a patient’s well-being and quality of life. Moreover, medication adherence, as indicated by discontinuation of treatment, is poor; evidence from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study showed that, in an 18-month period, subjects with schizophrenia had a discontinuation rate >74% and the median time to discontinuation of treatment was 6 months. The most important finding of the CATIE study was that antipsychotics differ more in their side-effect profile than in their efficacy. Indeed, the burden of side-effects is an important predictor of poor adherence. Therefore, improving sideeffect profiles is essential for the successful long-term management of schizophrenia. Understanding the safety and tolerability of currently available antipsychotics and matching them to patient needs is a critical first step. Newly available long-acting formulations of atypical antipsychotics may provide patients with a treatment option with an efficacy and safety profile suitable for the long-term management of schizophrenia. Moreover, longacting injectable antipsychotics can allow caregivers to manage and monitor adherence through a patients’ regular injection visits, as well as improve the therapeutic alliance. The strength of the relationship will rely, however, on clinicians communicating the potential advantages and disadvantages of long-acting injectable antipsychotics to patients and their caregivers. Disclosure statement: Max Schmauss has served on the speakers or advisory boards of AstraZeneca, Bristol-Myers-Squibb, Esparma, JanssenCilag, Lilly, Lundbeck, Merz Pharmaceuticals, Otsuka, Pfizer, and Servier.
C.03.02 Long-term management: how can longacting injectables benefit patients with schizophrenia? W. Fleischhacker1 ° 1 Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Innsbruck, Austria Schizophrenia is a chronic mental disorder, with the onset of symptoms in early adulthood. Treatment goals for the longterm management of the illness include maintaining periods of symptomatic remission, relapse prevention, reduced hospitalization, sustained adherence to medication and, ideally, psychosocial re-integration into society. Moreover, evidence has shown that the duration of untreated psychosis is a predictor of poor short- and long-term outcomes. Although there are a number of available antipsychotics for the treatment of schizophrenia, the long-term management of the disease still faces a number of challenges, such as improved long-term safety and efficacy of available medication, improved functioning and cognition with treatment, diverse responses by patients to different treatments,
C.03. Transforming the long-term management of schizophrenia
S. Kasper1 ° 1 Medical University of Vienna, Department of Biological Psychiatry and Psychotherapy, Vienna, Austria
C.03.01 Treatment options in schizophrenia
Both cognitive and non-cognitive symptoms cause burden for patients with mild cognitive impairment (MCI) and early dementia. Most dementia patients are affected by neuropsychiatric symptoms (NPS), such as apathy, depression, anxiety, or irritability. In MCI at least one NPS can be observed in almost half of the patients. Therefore treatment options have to be evaluated for their potential to alleviate these symptom clusters. Amnestic MCI: A recent meta-analysis suggests moderate beneficial effects of cognitive training on overall cognition and self-ratings. Recommendations for Mediterranean diet or polyunsaturated fatty acids (PUFAs) can be derived from epidemiological data, but evidence from intervention trials is still incomplete. Only marginal symptomatic improvements have been observed with cholinesterase inhibitors. Furthermore, a study on Ginkgo biloba leaf extract EGb 761® (240 mg/day) demonstrated improved attention, memory and quality of life. MCI with NPS: Interventions effective on cognition in MCI have been reported to alleviate NPS, too. Positive effects on mood have been reported for cognitive training and supplementation with PUFAs. A placebo-controlled clinical trial with EGb 761® in this specific population has just been completed. Dementia with NPS: Treatment of NPS in early dementia comprises elimination of modifiable causal factors, psychosocial interventions, and drugs. The GINDEM-NP [1], GOTADAY [2] and GOT-IT [3] studies showed that 240 mg/day EGb 761® improved cognitive function, NPS, activities of daily living and quality of life vs. placebo. Effects were comparable in dementia of the Alzheimer-type and vascular dementia. Cognitive improvement correlated with severity of baseline NPS in these trials. References [1] Napryeyenko, O., Borzenko, I., GINDEM-NP Study Group. 2007. Ginkgo biloba spezial extract in dementia with neuropsychiatric features. A randomised, placebo-controlled, double-blind clinical trial. Arzneimittelforschung Drug Res 57, 4−11. [2] Ihl, R., Tribanek, M., Bachinskaya, N., for the GOTADAY Study Group. Efficacy and Tolerability of a Once Daily Formulation of Ginkgo biloba Extract EGb 761® in Alzheimer’s Disease and Vascular Dementia: Results from a Randomised Controlled Trial. Pharmacopsychiatry 26, 1186–1194. [3] Herrschaft, H., Nacub, A., Likhachevc, S., Sholomovd, I., Hoerr, R., Schlaefke, S., on behalf of the GOT-IT! Study Group. Ginkgo biloba Extract EGb 761® in Dementia with Neuropsychiatric Features: A Randomised, Placebo-Controlled Trial to Confirm the Efficacy and Safety of a Daily Dose of 240 mg. Journal of Psychiatric Research, in press. Disclosure statement: Dr. Kasper has received grant/research support from Bristol Myers-Squibb, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Sepracor and Servier has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Lundbeck, Merck Sharp and Dome (MSD), Novartis, Organon, Pfizer, Schwabe, Sepracor, and Servier and has served on speakers’ bureaus for Angelini, AstraZeneca, Bristol Myers-Squibb, Eli Lilly, Janssen, Lundbeck, Pfizer, Pierre Fabre, Schwabe, Sepracor, and Servier.
S443
M. Schmauss1 ° 1 Bezirkskrankenhaus Augsburg, Department of Psychiatry, Augsburg, Germany Medication adherence is influenced by disease-related factors (insight, severity of illness, and length of illness), and medicationrelated factors (efficacy, safety, and tolerability). Evidence shows that non-adherence to medication is associated with increased relapse and rehospitalization rates, as well as poor patient outcomes. Therefore, the consequences of non-adherence may have a profound impact on a patient’s well-being and quality of life. Moreover, medication adherence, as indicated by discontinuation of treatment, is poor; evidence from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study showed that, in an 18-month period, subjects with schizophrenia had a discontinuation rate >74% and the median time to discontinuation of treatment was 6 months. The most important finding of the CATIE study was that antipsychotics differ more in their side-effect profile than in their efficacy. Indeed, the burden of side-effects is an important predictor of poor adherence. Therefore, improving sideeffect profiles is essential for the successful long-term management of schizophrenia. Understanding the safety and tolerability of currently available antipsychotics and matching them to patient needs is a critical first step. Newly available long-acting formulations of atypical antipsychotics may provide patients with a treatment option with an efficacy and safety profile suitable for the long-term management of schizophrenia. Moreover, longacting injectable antipsychotics can allow caregivers to manage and monitor adherence through a patients’ regular injection visits, as well as improve the therapeutic alliance. The strength of the relationship will rely, however, on clinicians communicating the potential advantages and disadvantages of long-acting injectable antipsychotics to patients and their caregivers. Disclosure statement: Max Schmauss has served on the speakers or advisory boards of AstraZeneca, Bristol-Myers-Squibb, Esparma, JanssenCilag, Lilly, Lundbeck, Merz Pharmaceuticals, Otsuka, Pfizer, and Servier.
C.03.02 Long-term management: how can longacting injectables benefit patients with schizophrenia? W. Fleischhacker1 ° 1 Medical University Innsbruck, Department of Psychiatry and Psychotherapy, Innsbruck, Austria Schizophrenia is a chronic mental disorder, with the onset of symptoms in early adulthood. Treatment goals for the longterm management of the illness include maintaining periods of symptomatic remission, relapse prevention, reduced hospitalization, sustained adherence to medication and, ideally, psychosocial re-integration into society. Moreover, evidence has shown that the duration of untreated psychosis is a predictor of poor short- and long-term outcomes. Although there are a number of available antipsychotics for the treatment of schizophrenia, the long-term management of the disease still faces a number of challenges, such as improved long-term safety and efficacy of available medication, improved functioning and cognition with treatment, diverse responses by patients to different treatments,