- Email: [email protected]
C.18.04 Measuring and monitoring patient outcomes -achieving positive outcomes with negative symptoms
C.19 Addressing the unmet needs in the long-term treatment of bipolar disorder cerebellum and back to the cortex as well as from limbic regions to the frontal cortex may be particularly important in patients with negative symptoms. Improved understanding of these circuits may help to optimise management with current pharmacological interventions and also aid the discovery of novel antipsychotics. C.18.03 Current therapeutic options for negative symptoms H.J. M¨oller ° . Ludwig-Maximilians-University, Department of Psychiatry, Munich, Germany Negative symptoms play an important role in short- and longterm schizophrenia outcomes as they are linked to functional abnormalities. During early schizophrenia pharmacotherapy, it was perceived that negative symptoms were secondary to treatment with conventional antipsychotics. Following the introduction of the atypical antipsychotics, however, optimism about the treatment of negative symptoms has greatly improved. Conventional agents should be avoided; evidence suggests that atypical antipsychotics are more effective than conventional agents in the treatment of negative symptoms and the prevention of secondary negative-symptom development. The therapeutic potential of atypical antipsychotics can be optimised using appropriate dosing supplemented with psychosocial therapies. Clinical trials have demonstrated that the currently available atypical antipsychotics are comparable in their monotherapeutic efficacy for the management of negative symptoms. On an individual basis, however, certain patients may respond more favourably to one particular agent and switching in refractory patients may be beneficial. Augmenting atypical antipsychotics with antidepressants, anxiolytics and mood stabilisers may target specific aspects of negative symptoms. Experimental approaches to existing atypical antipsychotic regimens are also being examined, including the addition of agents that improve glutamate function (e.g. D-cycloserine). Neuropsychopharmacological agents with unique human receptor-binding signatures may contribute to enhanced clinical efficacy and tolerability. The refinement of such characteristics will drive the development of next generation antipsychotic agents to provide benefits in terms of improved efficacy, tolerability and overall quality of life for patients with schizophrenia. C.18.04 Measuring and monitoring patient outcomes – achieving positive outcomes with negative symptoms N.R. Schooler ° . Georgetown University School of Medicine and the Washington DC Veterans Administration Hospital, Mental Illness Research Education and Clinical Cent, Washington DC, USA The effective management of negative signs and symptoms in schizophrenia is essential to optimise patient outcomes. This approach requires clinicians to be able to reliably measure and consistently monitor changes in negative symptoms. Insights into clinically relevant strategies for tracking progression of negative symptoms can be obtained through an appreciation of the tools frequently used to assess negative symptoms in clinical trials. The most common rating scales used to assess negative symptoms in schizophrenia include the negative subscale of the Positive and Negative Syndrome Scale (PANSS), the Schedule for the
S589
Assessment of Negative Symptoms (SANS) and the Negative Symptom Assessment (NSA). Each of these scales has potential advantages and disadvantages because they assess different aspects of negative symptomatology, employ distinct systems for scoring symptom severity and the time taken to complete patient assessments varies greatly. In large-scale, international, multicentre clinical trials, agreement among raters with respect to the quantification of negative symptoms may be further complicated by language differences and variations in cultural interpretation of symptoms. Furthermore, negative symptom-assessment scales have some limitations for clinics monitoring patients on a daily basis. Treatments that improve negative symptoms may reduce the considerable functional disability associated with schizophrenia. Thus, practical guidance for monitoring patients’ negative symptoms is required, with particular emphasis placed on strategies for differentiating negative symptoms from neurocognitive, affective and psychotic symptoms. Psychosocial approaches to obtaining best outcomes with negative symptoms are also of great importance in clinical practice.
C.19 Addressing the unmet needs in the long-term treatment of bipolar disorder Supported by an unrestricted educational grant from Eli Lilly and Company C.19.01 Treatment adherence and long-term outcomes of bipolar disorder M. Thase ° . University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, USA The unmet clinical needs of patients with bipolar disorder persist in all phases of the illness. Patients are symptomatic for virtually half of their lives regardless of any treatment regimen. This presentation will focus on the challenges with managing longterm stabilisation and will also address the prevalence and consequences of treatment nonadherence. In addition, this presentation will speak to the occurrence of relapse in patients with bipolar disorder. Data indicate approximately 40% of all patients who have bipolar disorder discontinue their treatment after only a few weeks. This presentation will assist practitioners identify and manage critical factors (such as lack of a support system and a proper diagnosis) contributing to medication nonadherence. It is imperative that practitioners collect patients’ perceptions of possible treatment alternatives as well as, evaluate the patientpractitioner relationship when designing or evaluating clinical services focused on enhancing treatment adherence. Previous studies indicate predictors and correlates of treatment nonadherence include multiple medications, denial, lack of patient insight, and substance abuse. Not surprisingly, 92% of all patients are on more than one medication, which often results in nonadherence to medical management. Thus, monotherapy for long-term maintenance is usually preferred. New evidence on the treatment adherence among pharmacotherapies with atypical antipsychotics as well as behavioural therapy will be explored in this presentation. Because of improved tolerability of atypical antipsychotics, the atypicals offer the potential of improved compliance and reduced risk of relapse.
S589
Assessment of Negative Symptoms (SANS) and the Negative Symptom Assessment (NSA). Each of these scales has potential advantages and disadvantages because they assess different aspects of negative symptomatology, employ distinct systems for scoring symptom severity and the time taken to complete patient assessments varies greatly. In large-scale, international, multicentre clinical trials, agreement among raters with respect to the quantification of negative symptoms may be further complicated by language differences and variations in cultural interpretation of symptoms. Furthermore, negative symptom-assessment scales have some limitations for clinics monitoring patients on a daily basis. Treatments that improve negative symptoms may reduce the considerable functional disability associated with schizophrenia. Thus, practical guidance for monitoring patients’ negative symptoms is required, with particular emphasis placed on strategies for differentiating negative symptoms from neurocognitive, affective and psychotic symptoms. Psychosocial approaches to obtaining best outcomes with negative symptoms are also of great importance in clinical practice.
C.19 Addressing the unmet needs in the long-term treatment of bipolar disorder Supported by an unrestricted educational grant from Eli Lilly and Company C.19.01 Treatment adherence and long-term outcomes of bipolar disorder M. Thase ° . University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, USA The unmet clinical needs of patients with bipolar disorder persist in all phases of the illness. Patients are symptomatic for virtually half of their lives regardless of any treatment regimen. This presentation will focus on the challenges with managing longterm stabilisation and will also address the prevalence and consequences of treatment nonadherence. In addition, this presentation will speak to the occurrence of relapse in patients with bipolar disorder. Data indicate approximately 40% of all patients who have bipolar disorder discontinue their treatment after only a few weeks. This presentation will assist practitioners identify and manage critical factors (such as lack of a support system and a proper diagnosis) contributing to medication nonadherence. It is imperative that practitioners collect patients’ perceptions of possible treatment alternatives as well as, evaluate the patientpractitioner relationship when designing or evaluating clinical services focused on enhancing treatment adherence. Previous studies indicate predictors and correlates of treatment nonadherence include multiple medications, denial, lack of patient insight, and substance abuse. Not surprisingly, 92% of all patients are on more than one medication, which often results in nonadherence to medical management. Thus, monotherapy for long-term maintenance is usually preferred. New evidence on the treatment adherence among pharmacotherapies with atypical antipsychotics as well as behavioural therapy will be explored in this presentation. Because of improved tolerability of atypical antipsychotics, the atypicals offer the potential of improved compliance and reduced risk of relapse.