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Maintenance treatment for schizophrenia
610
Abstracts
mOL PSVCIIlATRY 1996:39:500-666
infu!;jon proJuces inlracellular swelling. with incrctlsl:u mctaoolite relax· ation times, perhups due 10 the inhibition of the Na-K ATPase. Support~d by NIDA gr.tnL'i DA09448. DA04059. DAOOO64 and DAOOIIS.
374. FUNCTIONAL MAGNETIC RESONANCE STUDIES OF BRAIN ACTIVATION S. Posse Inslitute of M~dicinc, Resllurch Center JUlich GmbH. 0-52425 JUlich. Gcnnany Recent advances in functionul magnetic resonance imaging (fMRI) have stimulrlled considerable inlerest in applying this noninvasive approach to investigale the human bruin. From early investigations of Ihe visual anLl the motor system, applicalions or fMRI h:lVe muturcd to the demonstration of sublle activations associated whh complex neurological lasks involving langunge. memory and other higher bruin funclion!l. On lhe olher hand. il is clcar that Ihe current enlhusiasm for fMRI must be tempered with Ih~ rcalil.ation thai intc~n:lation of IinLlings cntilils a number of a.~sunlptions about image c;onlrJ.~1 mcchantsm.'i whic;h neccs~itatc .1 more prIlgmatic assessment of what is llctUlilly being mca.~urcd and how to compare the resulls to lhme or mon: eSlublishl:d function'll imaging tcc;hniques like positron emission IOmogmphy. MClabolic changes associate!! with neuronal nclivalion cun now be measured by functional magnetic resonance spectroscopy (fMRS) and funclional magnetic resonance spectroscopic imaging (fMRSI). Combination of these approaches wilh l'MRI may help to provide iI moru complete picture of vascular and metabolic mechanisms associated wilh brain function
375. MAINTENANCE TREATMENT FOR SCHIZOPHRENIA J. Kane
follow-up of patients with panic disordcr suggests that many continue to have residual symptoms. Complete remission. certninly in the abs~ncc of therapy. is rare. Afler successfulll}(!rapy with medication, conventional wisdom is to treat the patient fur a minimum of six monlhs following the la!it panic allack; however, the empirical basis for this length of Ireatment is lacking. :lnd relapse following mcLlication discontinualion is common. Relapse following cessiltion of benzooiuzepines may be highcr thnn following cessation of antidepressant medication in the Ircalment of panic disorder. Th~'1C has been a suggestion lhat successful complelion of a course of cognitive behavioml therapy (CBT) confers longer term remission than completion of an anti-panic medication regimen. but more recent evidcnce SUllge:;ts thai this may not be the case anc.lthllt residual symptoms remain cven aflcr CBT. Current recommendation is to tre:lt the patient with either medication for at Icast six months or COT for a complele course llmlthcn al1empt treatment diseonlinuution. TIle pmient is carefully instrocled about the risk of relapse and urged to resume Ircalment if panic anacks begin ugain. Studies are now underway 10 dclenuine if longer periods of medication may lead to better oulcomes once medication is discontinued and if OOos[er CBT scssions may produce improved and sustained remission.
377. MAINTENANCE TREATMENT FOR OBSESSIVE-COMPULSIVE DISORDER E. Hollandei, S. Cherkasky, C. Wong, R. Grossman, C.M. DcCaria, & B. Aronowitz
Department of Psychiatry. Albert Einstein College of Medicine, New York. NY Mllinlcnancc ilntipsychotie drug trcalment is ;\ critical modality in lhe lung-Icrm manugemem of schiwphrenia. Is has been well cstablisheLi in trials lasting 12 10 24 months th:ll rates of psychotic relapse can be substanlially rcduccd whcn patients receive prophylactic antipsychotic medication. At the same time. there is considerable helerogeneity in outcome, and valid predictors of relnp!>e vulnerability have nol been established. Il is :1150 clear that the long-lenn atiminiMrJtion of antipsychotic drogs is associated with u risk of :lbnonnal involuntary movcments (current estimales suggest 5% per )'c:lr of drug cxposure among patients whose DvcrDg~ uge is llpproximulcly 30). Recent research has focused on dosage reduction strulegics intended 10 improve the ovemll benelit-torisk TlIlio of long-term lreatment. Data lire now available on several humlrcd p:lticnl.'i panicipating in such triuls.
376. MAINTENANCE TREATMENT FOR PANIC DISORDER
J.M. Gorman Dcp;Jrtmcnl of Psyehilltry. College of Physicians & Surgeons of Columbin University, New York, NY Evidence continues to mount thut panic disorder is n chronic condition. Although Ilculc treatment is successful in mosl cascs. longer term
Department of Psychiatry. Mt. Sinlli School of Mcdicine. New York, NY Obsessh·c·compulsivc disorder (OCD) is a chronic disorder. and even with crfective treatment!! (serotonin rcuplakc inhibilors and behavior ther:lpy), residual symptoms remain, Our survey sludy of 701 OeD sufferers found thilt with appropriate treatmcnt. 62% or subjects have suslained improvement in overull qualily of life (Hollander et til 1995). Mainlenance studies in OCD address whether effective trealments remain effective with conlinucd lreatment and llssess relapse f'.Itcs with L1isconIinuation of treatment. A long-lcrm follow-up study in 84 OCD patients reported that most patients treatcd with SSRls for one to three yCllfS maintained or incrcascd symptom improvement (Orloff et al 1994). A double·bllnll senmlinc maintenance study showed su!;taincd improvement over one year (Greisl et al 1995). A six-month open Illbel maintenance p;lroxclinc lrial Ullmonstrailld significant improvement of OCD symptoms over time (Hollttnder et al. in review); however. high relapse rates have been reported following discontinuation of SSRJs in OCD. Eight)'-nin~ percent p:llicms discontinued from CMI to placebo relapsed within seven weeks (Pato et al 1988). and eight of nine palients switched from eM) to DM) relapsed (Lconarll et al 199 I). Four of five patienls disconlinued from nuoxctinc relapsed within eighl to 12 w~~ks (Pato 1991). Fifty-nine percent of patients blindly switched from parox· eline 10 pL'lcebo relapsed (28.S days to relapsc) versus 37% of patients blindly mnintaincd on puroxctine (62.9 lIays to relapse) (Hollander et Ill. in review). Risks. benefits. nnd future directions for maintenance treat· ment of OCD will be highlighted.
or
Abstracts
mOL PSVCIIlATRY 1996:39:500-666
infu!;jon proJuces inlracellular swelling. with incrctlsl:u mctaoolite relax· ation times, perhups due 10 the inhibition of the Na-K ATPase. Support~d by NIDA gr.tnL'i DA09448. DA04059. DAOOO64 and DAOOIIS.
374. FUNCTIONAL MAGNETIC RESONANCE STUDIES OF BRAIN ACTIVATION S. Posse Inslitute of M~dicinc, Resllurch Center JUlich GmbH. 0-52425 JUlich. Gcnnany Recent advances in functionul magnetic resonance imaging (fMRI) have stimulrlled considerable inlerest in applying this noninvasive approach to investigale the human bruin. From early investigations of Ihe visual anLl the motor system, applicalions or fMRI h:lVe muturcd to the demonstration of sublle activations associated whh complex neurological lasks involving langunge. memory and other higher bruin funclion!l. On lhe olher hand. il is clcar that Ihe current enlhusiasm for fMRI must be tempered with Ih~ rcalil.ation thai intc~n:lation of IinLlings cntilils a number of a.~sunlptions about image c;onlrJ.~1 mcchantsm.'i whic;h neccs~itatc .1 more prIlgmatic assessment of what is llctUlilly being mca.~urcd and how to compare the resulls to lhme or mon: eSlublishl:d function'll imaging tcc;hniques like positron emission IOmogmphy. MClabolic changes associate!! with neuronal nclivalion cun now be measured by functional magnetic resonance spectroscopy (fMRS) and funclional magnetic resonance spectroscopic imaging (fMRSI). Combination of these approaches wilh l'MRI may help to provide iI moru complete picture of vascular and metabolic mechanisms associated wilh brain function
375. MAINTENANCE TREATMENT FOR SCHIZOPHRENIA J. Kane
follow-up of patients with panic disordcr suggests that many continue to have residual symptoms. Complete remission. certninly in the abs~ncc of therapy. is rare. Afler successfulll}(!rapy with medication, conventional wisdom is to treat the patient fur a minimum of six monlhs following the la!it panic allack; however, the empirical basis for this length of Ireatment is lacking. :lnd relapse following mcLlication discontinualion is common. Relapse following cessiltion of benzooiuzepines may be highcr thnn following cessation of antidepressant medication in the Ircalment of panic disorder. Th~'1C has been a suggestion lhat successful complelion of a course of cognitive behavioml therapy (CBT) confers longer term remission than completion of an anti-panic medication regimen. but more recent evidcnce SUllge:;ts thai this may not be the case anc.lthllt residual symptoms remain cven aflcr CBT. Current recommendation is to tre:lt the patient with either medication for at Icast six months or COT for a complele course llmlthcn al1empt treatment diseonlinuution. TIle pmient is carefully instrocled about the risk of relapse and urged to resume Ircalment if panic anacks begin ugain. Studies are now underway 10 dclenuine if longer periods of medication may lead to better oulcomes once medication is discontinued and if OOos[er CBT scssions may produce improved and sustained remission.
377. MAINTENANCE TREATMENT FOR OBSESSIVE-COMPULSIVE DISORDER E. Hollandei, S. Cherkasky, C. Wong, R. Grossman, C.M. DcCaria, & B. Aronowitz
Department of Psychiatry. Albert Einstein College of Medicine, New York. NY Mllinlcnancc ilntipsychotie drug trcalment is ;\ critical modality in lhe lung-Icrm manugemem of schiwphrenia. Is has been well cstablisheLi in trials lasting 12 10 24 months th:ll rates of psychotic relapse can be substanlially rcduccd whcn patients receive prophylactic antipsychotic medication. At the same time. there is considerable helerogeneity in outcome, and valid predictors of relnp!>e vulnerability have nol been established. Il is :1150 clear that the long-lenn atiminiMrJtion of antipsychotic drogs is associated with u risk of :lbnonnal involuntary movcments (current estimales suggest 5% per )'c:lr of drug cxposure among patients whose DvcrDg~ uge is llpproximulcly 30). Recent research has focused on dosage reduction strulegics intended 10 improve the ovemll benelit-torisk TlIlio of long-term lreatment. Data lire now available on several humlrcd p:lticnl.'i panicipating in such triuls.
376. MAINTENANCE TREATMENT FOR PANIC DISORDER
J.M. Gorman Dcp;Jrtmcnl of Psyehilltry. College of Physicians & Surgeons of Columbin University, New York, NY Evidence continues to mount thut panic disorder is n chronic condition. Although Ilculc treatment is successful in mosl cascs. longer term
Department of Psychiatry. Mt. Sinlli School of Mcdicine. New York, NY Obsessh·c·compulsivc disorder (OCD) is a chronic disorder. and even with crfective treatment!! (serotonin rcuplakc inhibilors and behavior ther:lpy), residual symptoms remain, Our survey sludy of 701 OeD sufferers found thilt with appropriate treatmcnt. 62% or subjects have suslained improvement in overull qualily of life (Hollander et til 1995). Mainlenance studies in OCD address whether effective trealments remain effective with conlinucd lreatment and llssess relapse f'.Itcs with L1isconIinuation of treatment. A long-lcrm follow-up study in 84 OCD patients reported that most patients treatcd with SSRls for one to three yCllfS maintained or incrcascd symptom improvement (Orloff et al 1994). A double·bllnll senmlinc maintenance study showed su!;taincd improvement over one year (Greisl et al 1995). A six-month open Illbel maintenance p;lroxclinc lrial Ullmonstrailld significant improvement of OCD symptoms over time (Hollttnder et al. in review); however. high relapse rates have been reported following discontinuation of SSRJs in OCD. Eight)'-nin~ percent p:llicms discontinued from CMI to placebo relapsed within seven weeks (Pato et al 1988). and eight of nine palients switched from eM) to DM) relapsed (Lconarll et al 199 I). Four of five patienls disconlinued from nuoxctinc relapsed within eighl to 12 w~~ks (Pato 1991). Fifty-nine percent of patients blindly switched from parox· eline 10 pL'lcebo relapsed (28.S days to relapsc) versus 37% of patients blindly mnintaincd on puroxctine (62.9 lIays to relapse) (Hollander et Ill. in review). Risks. benefits. nnd future directions for maintenance treat· ment of OCD will be highlighted.
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