- Email: [email protected]
Compliance in schizophrenia
S233
P2 Psychotic disorders and antipsychotics is important to assess whether this increased cost is offset by other healthcare resource savings over the long-term. Quetiapine (Seroquel), a new atypical antipsychotic, has consistently been shown to be more effective than placebo in the treatment of positive and negative symptoms of schizophrenia and does not differ significantly from placebo in the incidence of EPS across the full dose range (150750 mg/day) or in changes of plasma prolactin levels. Several ongoing economic evaluations have been set up to provide trial-based evidence of quetiapine’s relative long-term cost-effectiveness (Drummond et al. 1998). The aim of this retrospective study was to audit patients in one centre in the UK to gain a preliminary insight into the health economic attributes of quetiapine over the long-term. The study design was a case series and the patient sample consisted of all patients entered into an open-label extension of a 6-week trial in one study centre in the UK, which formed part of a larger multicentre efficacy study (King et al. 1998). Resource utilisation data were collected retrospectively for a 12-month period before patients were given quetiapine and for a period of 12 months after. Data collected included direct costs of care (inpatient, outpatient, residential and community care). Results are presented on 20 patients. Mean BPRS scores fell significantly in the period after patients were administered quetiapine from 30 to 15 (p < 0.005) and mean Simpson scale scores fell significantly from 18 to 10 (p < 0.005). In patients who remained on study medication for 12 months (n = 12) the mean cost per patient fell by 14%. Decreased hospital stay was the biggest factor in this reduction. In patients who withdrew from study medication (n = 8), only 4 patients had an increase in hospital stay after commencing quetiapine and of these, 3 had been classified as previous non-responders to antipsychotic medications. This audit suggests that treatment with quetiapine is associated with clinical improvements over the period of a year which potentially reduce overall healthcare costs and offset the increased cost of drug treatment. The results of a number of longer-term health economic evaluations are awaited to provide further evidence on the cost-effectiveness of quetiapine. Seroquel is a trademark, the property of ZENECA Ltd.
References [1]
Dmmmond,M.F., Knapp, M.R.J., Bum, T.P.,Miller, K.D. and Shadwell,I?
(1998)Issues in the Design of Studies for the EconomicEvaluationof New Atypical Antipsychotics: the EST0 study. J. Mental Health Policy Econom. 1, 15-22. [2] King, D.J., Link, C.G.G. and Kowalcyk, B. A comparison of bid and tid dose regimens of quetiapine (‘Seroquel’) in the treatment of schizophrenia. Psychopharmacology (in press).
lp.2.066)
Compliance
in schizophrenia
V Novak-GrubiE, R. TavEar’. Psychiatric Ljuhljana-Polje, Slovenia
Clinic, Studenec 48, U-1260
Advances in psychopharmacology enable better therapeutic efficacy and prevention of relapse of schizophrenia. Unfortunately many patients refuse to take the prescribed drugs and drop out of treatment after being discharged from the hospital. Many factors influencing noncompliance have been identified. However, the studies have a variety of methodological differences, so the results are hard to compare. The aim of our study was to identify factors influencing noncompliance in a group of first admitted patients with schizophrenia, schizophreniform disorder and schizoaffective disorder. Fifty-six patients were enrolled in the prospective study at the Ljubljana Psychiatric Clinic and the association between demographic and disease-related factors to compliance was assessed. We have included first-time admitted male patients under same treatment conditions. Psychopathological symptoms and extrapyramidal side effects were assessed with PANSS Simpson-Angus Scale and Barnes Akatbisia Scale at admission and discharge. Patients were followed up for one year after discharge. Non-compliance was defined as dropping out of treatment (at least one missed appointment). Predictors of non-compliance were identified with Cox survival analysis.
Thirty patients (53.6%) dropped out of treatment in the first year, most of them in the First three months. Non-compliance was associated with diagnosis of schizophrenia vs. diagnosis of schizoaffective and schizophreniform disorder. Positive symptoms at admission and lack of insight at discharge also predicted non-compliance. Sociodemographic factors and extrapyramidal side effects were not related to non-compliance. Our data are in accordance with the results of other studies on drug compliance. Diagnosis of schizophrenia, psychopathological symptoms and lack of insight strongly predicted non-compliance. References
[I]
Fenton, W.S., Blyler, CR. and Heinssen, R.K. (1997) Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr. Bull. 23, 637451. [2] Piatkowska, 0. and Famill, D. (1992) Medication - compliance or alliance? A client centred approach to increasing adherence. In: Cavanagb, D.J. (Ed.), Schizophrenia - An overview and practical handbook. Chapman & Hall, London, pp 339-355. [3] Buchanan, A. (1996) Compliance with treatment in schizophrenia. Maudsley Monograph, Psychology Press, London.
lp.2.067)
Riaperidone augmentation of clozapine olanzapine for refractory schizophrenia
and
1. Mantonakis, K. Kattan, I.M. Zervas. Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece The use of risperidone as an augmentation strategy to unsuccesful treatment with clozapine in refractory schizophrenia has recently been
reported in the literature (1). Although some have raised concern that such a combination may carry an increased risk for agranulocytosis (2), we have recently reported favorably on the safety of this combination in a series of 12 patients (3). In this report we describe our experience with a risperidone-clozapine combination in three patients refractory to multiple neuroleptics, including independent trials of risperidone and clozapine. Further, we will be reporting results from a risperidone augmentation strategy in three refractory schizophrenic patients for whom maximal doses of olanzapine had yielded no result. The three patients receiving the clozapine-risperidone combination were one 29 year old male with paranoid schizophrenia of three years duration, one 27 year old female patient with an eight year history of schizoaffective disorder and one 3 1 year old male with a longstanding history of disorganized schizophrenia. All three had a preponderance of negative symptoma at the time of the investigation. All of them had been tried on adequate doses of multiple classical neuroleptics, including risperidone, with minimal or no improvement. At this stage they had all been given adequate trials of clozapine with no improvement. When risperidone was added to the regimen the first two patients had remarkable responses. The female patient had no side effects but the male patient developed significant head tremor controlled by the addition of propranolol. The third patient showed no response to the combination. The different pharmacological profiles of the two drags may be synergistically responsible for the improvement observed. Three additional male patients with both positive and negative symptoms, two with paranoid schizophrenia (aged 21 and 30) and one with disorganized schizophrenia (24 years old), refractory to all treatments including classical neuroleptics and independent trials of risperidone, clozapine and recently olanzapine (up to 25 mg), were given risperidone augmentation of olanzapine. Significant improvement was observed in one. In the other two results are pending, as they have only recently been placed on the combination. References fl] McCarthy RH, Terkelsen KG: Risperidone augmentation of clozapine. Pharmacopsychiatry 28: 61-63, 1995 [2] Godlesky LS, Semyak MJ: Agmnulocytosis after addition of risperidone to clozapine treatment. Am J Psychiatry 153 (5): 735-6, 1996 [3] Zervas IM, Mantonakis I, K&tan K: Risperidone-Clozapine combination for refractory schizophrenia. European Nemopsychopharmacology 8: Suppl 1, S37
P2 Psychotic disorders and antipsychotics is important to assess whether this increased cost is offset by other healthcare resource savings over the long-term. Quetiapine (Seroquel), a new atypical antipsychotic, has consistently been shown to be more effective than placebo in the treatment of positive and negative symptoms of schizophrenia and does not differ significantly from placebo in the incidence of EPS across the full dose range (150750 mg/day) or in changes of plasma prolactin levels. Several ongoing economic evaluations have been set up to provide trial-based evidence of quetiapine’s relative long-term cost-effectiveness (Drummond et al. 1998). The aim of this retrospective study was to audit patients in one centre in the UK to gain a preliminary insight into the health economic attributes of quetiapine over the long-term. The study design was a case series and the patient sample consisted of all patients entered into an open-label extension of a 6-week trial in one study centre in the UK, which formed part of a larger multicentre efficacy study (King et al. 1998). Resource utilisation data were collected retrospectively for a 12-month period before patients were given quetiapine and for a period of 12 months after. Data collected included direct costs of care (inpatient, outpatient, residential and community care). Results are presented on 20 patients. Mean BPRS scores fell significantly in the period after patients were administered quetiapine from 30 to 15 (p < 0.005) and mean Simpson scale scores fell significantly from 18 to 10 (p < 0.005). In patients who remained on study medication for 12 months (n = 12) the mean cost per patient fell by 14%. Decreased hospital stay was the biggest factor in this reduction. In patients who withdrew from study medication (n = 8), only 4 patients had an increase in hospital stay after commencing quetiapine and of these, 3 had been classified as previous non-responders to antipsychotic medications. This audit suggests that treatment with quetiapine is associated with clinical improvements over the period of a year which potentially reduce overall healthcare costs and offset the increased cost of drug treatment. The results of a number of longer-term health economic evaluations are awaited to provide further evidence on the cost-effectiveness of quetiapine. Seroquel is a trademark, the property of ZENECA Ltd.
References [1]
Dmmmond,M.F., Knapp, M.R.J., Bum, T.P.,Miller, K.D. and Shadwell,I?
(1998)Issues in the Design of Studies for the EconomicEvaluationof New Atypical Antipsychotics: the EST0 study. J. Mental Health Policy Econom. 1, 15-22. [2] King, D.J., Link, C.G.G. and Kowalcyk, B. A comparison of bid and tid dose regimens of quetiapine (‘Seroquel’) in the treatment of schizophrenia. Psychopharmacology (in press).
lp.2.066)
Compliance
in schizophrenia
V Novak-GrubiE, R. TavEar’. Psychiatric Ljuhljana-Polje, Slovenia
Clinic, Studenec 48, U-1260
Advances in psychopharmacology enable better therapeutic efficacy and prevention of relapse of schizophrenia. Unfortunately many patients refuse to take the prescribed drugs and drop out of treatment after being discharged from the hospital. Many factors influencing noncompliance have been identified. However, the studies have a variety of methodological differences, so the results are hard to compare. The aim of our study was to identify factors influencing noncompliance in a group of first admitted patients with schizophrenia, schizophreniform disorder and schizoaffective disorder. Fifty-six patients were enrolled in the prospective study at the Ljubljana Psychiatric Clinic and the association between demographic and disease-related factors to compliance was assessed. We have included first-time admitted male patients under same treatment conditions. Psychopathological symptoms and extrapyramidal side effects were assessed with PANSS Simpson-Angus Scale and Barnes Akatbisia Scale at admission and discharge. Patients were followed up for one year after discharge. Non-compliance was defined as dropping out of treatment (at least one missed appointment). Predictors of non-compliance were identified with Cox survival analysis.
Thirty patients (53.6%) dropped out of treatment in the first year, most of them in the First three months. Non-compliance was associated with diagnosis of schizophrenia vs. diagnosis of schizoaffective and schizophreniform disorder. Positive symptoms at admission and lack of insight at discharge also predicted non-compliance. Sociodemographic factors and extrapyramidal side effects were not related to non-compliance. Our data are in accordance with the results of other studies on drug compliance. Diagnosis of schizophrenia, psychopathological symptoms and lack of insight strongly predicted non-compliance. References
[I]
Fenton, W.S., Blyler, CR. and Heinssen, R.K. (1997) Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr. Bull. 23, 637451. [2] Piatkowska, 0. and Famill, D. (1992) Medication - compliance or alliance? A client centred approach to increasing adherence. In: Cavanagb, D.J. (Ed.), Schizophrenia - An overview and practical handbook. Chapman & Hall, London, pp 339-355. [3] Buchanan, A. (1996) Compliance with treatment in schizophrenia. Maudsley Monograph, Psychology Press, London.
lp.2.067)
Riaperidone augmentation of clozapine olanzapine for refractory schizophrenia
and
1. Mantonakis, K. Kattan, I.M. Zervas. Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece The use of risperidone as an augmentation strategy to unsuccesful treatment with clozapine in refractory schizophrenia has recently been
reported in the literature (1). Although some have raised concern that such a combination may carry an increased risk for agranulocytosis (2), we have recently reported favorably on the safety of this combination in a series of 12 patients (3). In this report we describe our experience with a risperidone-clozapine combination in three patients refractory to multiple neuroleptics, including independent trials of risperidone and clozapine. Further, we will be reporting results from a risperidone augmentation strategy in three refractory schizophrenic patients for whom maximal doses of olanzapine had yielded no result. The three patients receiving the clozapine-risperidone combination were one 29 year old male with paranoid schizophrenia of three years duration, one 27 year old female patient with an eight year history of schizoaffective disorder and one 3 1 year old male with a longstanding history of disorganized schizophrenia. All three had a preponderance of negative symptoma at the time of the investigation. All of them had been tried on adequate doses of multiple classical neuroleptics, including risperidone, with minimal or no improvement. At this stage they had all been given adequate trials of clozapine with no improvement. When risperidone was added to the regimen the first two patients had remarkable responses. The female patient had no side effects but the male patient developed significant head tremor controlled by the addition of propranolol. The third patient showed no response to the combination. The different pharmacological profiles of the two drags may be synergistically responsible for the improvement observed. Three additional male patients with both positive and negative symptoms, two with paranoid schizophrenia (aged 21 and 30) and one with disorganized schizophrenia (24 years old), refractory to all treatments including classical neuroleptics and independent trials of risperidone, clozapine and recently olanzapine (up to 25 mg), were given risperidone augmentation of olanzapine. Significant improvement was observed in one. In the other two results are pending, as they have only recently been placed on the combination. References fl] McCarthy RH, Terkelsen KG: Risperidone augmentation of clozapine. Pharmacopsychiatry 28: 61-63, 1995 [2] Godlesky LS, Semyak MJ: Agmnulocytosis after addition of risperidone to clozapine treatment. Am J Psychiatry 153 (5): 735-6, 1996 [3] Zervas IM, Mantonakis I, K&tan K: Risperidone-Clozapine combination for refractory schizophrenia. European Nemopsychopharmacology 8: Suppl 1, S37