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C.09.01 How can we help our patients with schizophrenia adhere to their medication?
C.09. Effective long-term treatment of schizophrenia: are we there yet? References [1] Demyttenaere, K., Bonnewyn, A., Bruffaerts, R., et al. 2008 Comorbid painful physical symptoms and anxiety: prevalence, work loss and helpseeking. J Affect Disord 109, 264–272. [2] Bair, M.J., Wu, J., Damush, T.M., et al. 2008 Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 70, 890–897. [3] Teh, C.F., Morone, N.E., Karp, J.F., et al. 2009 Pain interference impacts response to treatment for anxiety disorders. Depress Anxiety 26, 222– 228. Disclosure statement: Rakesh Jain: speaker and consultant (Pfizer), received research support (Pfizer).
C.08.03 The neurobiology and psychopharmacology of GAD J.A. Den Boer1 ° . 1 University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands Neurobiological research in generalised anxiety disorder (GAD) has been hampered by uncertainties concerning the diagnostic independence of the disorder. During the past few years, research has identified several candidate genes, but their significance is still unclear. Neuroimaging studies have shown increased activity in the fear circuitry of the brain. When focusing on worrying as a central feature of GAD, studies using functional magnetic resonance imaging have shown that there is increased amygdala activity as a neural correlate of negative expectations of the future [1]. This may lead to support from neurobiological findings for theories of cognitive dysfunction in anxiety disorders. It might be argued that increased amygdala activity represents an enhanced anticipatory emotional response in GAD, and may explain why worrying is the core symptom of the disorder. Recent evidence-based guidelines for pharmacological management have recommended, as first-line treatment for GAD, the selective serotonin reuptake inhibitors escitalopram, paroxetine and sertraline,a the serotonin-norepinephrine reuptake inhibitors venlafaxine and duloxetine and the calcium channel modulator pregabalin [2]. Efficacy has been observed with the atypical antipsychotic quetiapine,a but these results must be seen as preliminary [2]. There is a paucity of studies in treatment-resistant (TR) GAD. In recent years, several clinical trials on adjunctive use of atypical antipsychotics for TR GAD have been published. Available evidence from controlled studies indicates significant reductions on HAM-A scales for risperidone and olanzapine in TR GAD. One placebo-controlled add-on study using augmentation with pregabalin in TR GAD has suggested good efficacy [3]. a Sertraline and quetiapine are not licensed for the treatment of GAD in Europe. References [1] Nitschke, J.B., Sarinopoulos, I., Oathes, D.J., et al. 2009 Anticipatory activation in the amygdala and anterior cingulate in generalized anxiety disorder and prediction of treatment response. Am J Psychiatry 166, 302–310. [2] Bandelow, B., Zohar, J., Hollander, E., et al. 2008 World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders − first revision. World J Biol Psychiatry 9, 248–312. [3] Weaver, J., Miceli, J., Shiovitz, T., et al. 2009 Adjunctive pregabalin after partial response to SSRI or SNRI in GAD: results of a doubleblind, placebo-controlled trial. Eur Neuropsychopharm 19 (Suppl. 3), S593–S594. Disclosure statement: Johan A. Den Boer: Grants and/or advisor: Servier, Pfizer, Solvay, Eli Lilly
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C.09. Effective long-term treatment of schizophrenia: are we there yet? C.09.01 How can we help our patients with schizophrenia adhere to their medication? R. Emsley1 ° . 1 University of Stellenbosch, Department of Psychiatry, Cape Town, South Africa Ensuring patients continue with their medication is central to the management of schizophrenia to ensure they achieve maximum treatment benefits and to shape long-term outcomes. While the risks of relapse and hospitalization are reduced if adequate adherence can be maintained, for patients with schizophrenia, as with other chronic conditions, medication adherence is poor. Partial and non-adherence to medication can be due to many, often overlapping factors, amongst which, patient insight of their illness is perceived by psychiatrists to be one of the most important reasons for them discontinuing their medication [1]. In the early years of illness, partial or non-adherence to antipsychotic medication is particularly common, with resultant high rates of relapse and unsustained symptom remission. Thus, effective intervention during this early phase of the disorder that achieves and maintains remission may forecast a more positive future for the patient. There is a range of pharmacological and psychosocial interventions available aimed at improving treatment adherence [2]. Amongst the antipsychotic drug treatment options, the use of longacting injectable formulations in early psychosis is associated with low discontinuation rates. In addition to examining the effect of risperidone long-acting injectable on remission rates and relapse from a 24-month, open-label study in 50 patients with firstepisode psychosis [3], an extension study has been conducted in remitted patients who discontinue treatment, showing very high recurrence rates and the absence of early warning signs of relapse. Subsequent response following recommencement of the same treatment is also investigated. References [1] Emsley, R., Alptekin, K., Ca˜nas, F., Gorwood, P., Naber, D., Olivares, J.M., Roca, M., Martinez, G., Schreiner, A., 2010 Physician awareness of partial and non-adherence to antipsychotic medication in schizophrenia: results from a survey conducted across Europe, the Middle East and Africa (EMEA). Poster presented at IEPA, November 29– December 1 2010, Amsterdam, The Netherlands. [2] Velligan, D.I., Weiden, P.J., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., Docherty, J.P.; Expert Consensus Panel on Adherence Problems in Serious and Persistent Mental Illness. 2009 The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 70(suppl 4), 1−46. [3] Emsley, R., Oosthuizen, P., Koen, L., Niehaus, D.J., Medori, R., Rabinowitz, J., 2008 Remission in patients with first-episode schizophrenia receiving assured antipsychotic medication: a study with risperidone long-acting injection. Int Clin Psychopharmacol 23, 325–331. Disclosure statement: Robin Emsley has received advisory board/lecture honoraria from AstraZeneca, Bristol-Myers Squibb, Janssen, Lilly, Lundbeck, Organon, Pfizer, Servier and Wyeth. He has been involved in clinical trials sponsored by AstraZeneca, Bristol-Myers Squibb, Janssen, Lilly, Lundbeck, Novartis, Organon, Pfizer, sanofi-aventis, Servier, Solvay and Wyeth. He has received research funding from AstraZeneca, Janssen and Lundbeck.
C.08.03 The neurobiology and psychopharmacology of GAD J.A. Den Boer1 ° . 1 University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands Neurobiological research in generalised anxiety disorder (GAD) has been hampered by uncertainties concerning the diagnostic independence of the disorder. During the past few years, research has identified several candidate genes, but their significance is still unclear. Neuroimaging studies have shown increased activity in the fear circuitry of the brain. When focusing on worrying as a central feature of GAD, studies using functional magnetic resonance imaging have shown that there is increased amygdala activity as a neural correlate of negative expectations of the future [1]. This may lead to support from neurobiological findings for theories of cognitive dysfunction in anxiety disorders. It might be argued that increased amygdala activity represents an enhanced anticipatory emotional response in GAD, and may explain why worrying is the core symptom of the disorder. Recent evidence-based guidelines for pharmacological management have recommended, as first-line treatment for GAD, the selective serotonin reuptake inhibitors escitalopram, paroxetine and sertraline,a the serotonin-norepinephrine reuptake inhibitors venlafaxine and duloxetine and the calcium channel modulator pregabalin [2]. Efficacy has been observed with the atypical antipsychotic quetiapine,a but these results must be seen as preliminary [2]. There is a paucity of studies in treatment-resistant (TR) GAD. In recent years, several clinical trials on adjunctive use of atypical antipsychotics for TR GAD have been published. Available evidence from controlled studies indicates significant reductions on HAM-A scales for risperidone and olanzapine in TR GAD. One placebo-controlled add-on study using augmentation with pregabalin in TR GAD has suggested good efficacy [3]. a Sertraline and quetiapine are not licensed for the treatment of GAD in Europe. References [1] Nitschke, J.B., Sarinopoulos, I., Oathes, D.J., et al. 2009 Anticipatory activation in the amygdala and anterior cingulate in generalized anxiety disorder and prediction of treatment response. Am J Psychiatry 166, 302–310. [2] Bandelow, B., Zohar, J., Hollander, E., et al. 2008 World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders − first revision. World J Biol Psychiatry 9, 248–312. [3] Weaver, J., Miceli, J., Shiovitz, T., et al. 2009 Adjunctive pregabalin after partial response to SSRI or SNRI in GAD: results of a doubleblind, placebo-controlled trial. Eur Neuropsychopharm 19 (Suppl. 3), S593–S594. Disclosure statement: Johan A. Den Boer: Grants and/or advisor: Servier, Pfizer, Solvay, Eli Lilly
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C.09. Effective long-term treatment of schizophrenia: are we there yet? C.09.01 How can we help our patients with schizophrenia adhere to their medication? R. Emsley1 ° . 1 University of Stellenbosch, Department of Psychiatry, Cape Town, South Africa Ensuring patients continue with their medication is central to the management of schizophrenia to ensure they achieve maximum treatment benefits and to shape long-term outcomes. While the risks of relapse and hospitalization are reduced if adequate adherence can be maintained, for patients with schizophrenia, as with other chronic conditions, medication adherence is poor. Partial and non-adherence to medication can be due to many, often overlapping factors, amongst which, patient insight of their illness is perceived by psychiatrists to be one of the most important reasons for them discontinuing their medication [1]. In the early years of illness, partial or non-adherence to antipsychotic medication is particularly common, with resultant high rates of relapse and unsustained symptom remission. Thus, effective intervention during this early phase of the disorder that achieves and maintains remission may forecast a more positive future for the patient. There is a range of pharmacological and psychosocial interventions available aimed at improving treatment adherence [2]. Amongst the antipsychotic drug treatment options, the use of longacting injectable formulations in early psychosis is associated with low discontinuation rates. In addition to examining the effect of risperidone long-acting injectable on remission rates and relapse from a 24-month, open-label study in 50 patients with firstepisode psychosis [3], an extension study has been conducted in remitted patients who discontinue treatment, showing very high recurrence rates and the absence of early warning signs of relapse. Subsequent response following recommencement of the same treatment is also investigated. References [1] Emsley, R., Alptekin, K., Ca˜nas, F., Gorwood, P., Naber, D., Olivares, J.M., Roca, M., Martinez, G., Schreiner, A., 2010 Physician awareness of partial and non-adherence to antipsychotic medication in schizophrenia: results from a survey conducted across Europe, the Middle East and Africa (EMEA). Poster presented at IEPA, November 29– December 1 2010, Amsterdam, The Netherlands. [2] Velligan, D.I., Weiden, P.J., Sajatovic, M., Scott, J., Carpenter, D., Ross, R., Docherty, J.P.; Expert Consensus Panel on Adherence Problems in Serious and Persistent Mental Illness. 2009 The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry 70(suppl 4), 1−46. [3] Emsley, R., Oosthuizen, P., Koen, L., Niehaus, D.J., Medori, R., Rabinowitz, J., 2008 Remission in patients with first-episode schizophrenia receiving assured antipsychotic medication: a study with risperidone long-acting injection. Int Clin Psychopharmacol 23, 325–331. Disclosure statement: Robin Emsley has received advisory board/lecture honoraria from AstraZeneca, Bristol-Myers Squibb, Janssen, Lilly, Lundbeck, Organon, Pfizer, Servier and Wyeth. He has been involved in clinical trials sponsored by AstraZeneca, Bristol-Myers Squibb, Janssen, Lilly, Lundbeck, Novartis, Organon, Pfizer, sanofi-aventis, Servier, Solvay and Wyeth. He has received research funding from AstraZeneca, Janssen and Lundbeck.