- Email: [email protected]
P.2.078 New insights in the therapeutic adherence in schizophrenia
$266
•
P2, Psychotic disorders and caztipsye#otics
Long-term clinical effectiveness of quelJapine in first-episode psychosis
L, Kopala 1, H, Millikan 2, D, Whitehorn 2, Q, Rui 2, H, Woodley 2, K.P. Good 2, i University of British Columbia, Ce~er for Complex
Brain Disorders, Department of Psychiatry, Vancouver, Canada; 2Dalhousie University, Department of Psychiatry, Halifax, Canada Purpose: The benefits of early diagnosis and optimal treatment of first-episode psychosis are well established, as are the benefits of second generation antipsychotic medications, However, neither dosing nor long-term clinical effectiveness of the atypical antipsychotic quetiapine have been described in this population. This study addresses these shortcomings by examining long-term clinical, cognitive and qualib/of life (QoL) outcomes, and dosing issues in a representative sample of patients with first-episode psychosis, Methods: This was a 2-year, open-label study of patients with schizophrenia spectrum disorder and first-episode psychosis. Clinical and cognitive data were collected every 3 months while the Wisconsin QoL index (W-QLI) data were collected at 6, 12 and 2d months. Statistical analysis used paired and unpaired t-tests. Resttl~: Thirty-nine patients (7 female, 32 male; mean age, 23.2 years) were enrolled, of whom, 21 patients completed the 2-year study The mean dose of quetiapine was 540 ms/day at Year 1, which increased to 605 mg/day at Year 2. The majority (26/39, 67%) of patients had been previously treated with an antipsychotic for a mean (SD) of 10.3 (7.2) weeks. At Year 2, quetiapine significantly irrproved mean scores for Positive and Negative Syndrome Subscale (baseline 66.6; Year 2, 40.3; p<0.0001), Global Assessment of Function (baseline, 39; Year 2, 74.7; p<0.0001), and Social and Occupational Function (baseline,, 48.9; Year 2, 78.1; p<0.0001). Furthermore, quetiapine treatment was associated with a significant improvement in mood, as assessed by the Calgary Depression Scale for Schizophrenia (baseline, 5.5; Year 2, 2.1; p=0.006). After 6 months' treatment, quefiapine significantly improved QoL (general satisfaction, psychological wellbeing, symptoms/outlook, activities of daily living [ADL], and weighted and unweighted W-QLI). With the exception of ADL, all aspects remained significant at Year 1; Year 2 data will be presented. All patients demonstrated an improvement in motor function over the tveo years as assessed by the Extrapyramidal Syndrome Rating Scale; improvements in akathisia were significant at Year 1 (p=0.047) and approached significance at Year 2 (p=0.057). Regarding cognitive function, patients showed a significant improvement in attention and executive function at Year 2 (p<0.05). Generally, quetiapine was wall tolerated: no patients required anticholinergics or beta blockers for extrapyramidal signs or symptoms (EPS), no glucose dysregulation was experienced and no case of diabetes was recorded. Moreover, quetiapine treatment was not associated with significant changes in cholesterol levels. Triglyceride levels increased slightly from baseline (1.4 mmol/L) to Year 1 (1.8 mmol/L); however there was no appreciable increase to Year 2 (1.9 mmol/L). C e n e l ~ i o m In patients with first-episode psychosis, quetiapine was effective in the treatment of positive and negative psychotic symptoms while improving various domains of cognitive function, and QoL. Importantly, quetiapine treatment did not result in drug-induced EPS; in fact, pre-existing abnormal motor function improved over time. Dosing stra~gies for this population will be described,
•
N
e
w
insights in the therapeutic adherence in schizophrenia
J. Qiner 1, M. Roca 2, F. Cafias 3, A. Rodriguez 4, I.M. Olivares 5, A. Rodr{guez-Morales 6, J.A. BurSn 6 *, G. Martinez-Junquera ~, A D H Spanish Group for the Study of Therapeutic Adherence in Schizophrenia r . iHo#pitai Unioersitario Yirgen &l IRoc{o,
Psy&iat,ry, Seuilla, Spain; 2Hospital Unioersitario Palma de MaEorca, Psychiatry, Palma de MaEorca, 5~ain; 3Hospital Rodr@uez Lafora, Psychiatry, Madrid, 5pain; ~IMPU, Psychiatry, Barcelona, @sin; JHospital Xeral Islas Cfes, Psychiatry, P]go, Spain; 6Ja~sen-Cilag, @ain, Medical Department, Madrid Spain; 7ADHES Project, Psychiatry, @ain, Spain Objective: To evaluate, the approach of Spanish psychiatrists to the non-adherence issue in the treatment of psychotic patients. This survey was the first initiative in the ADHES Project. This ambitious project aims to identify and measure the relevant variables that are involved in the compliance of schizophrenic patients. Methe& A multicenter e-questionnaire in a PDA platform as data enter tracking system, was issued to one tenth of Spanish Psychiatrists, from 1st of March to 31 st of May 2003. Psychiatrists screened the therapeutic compliance of schizophrenic patients using a nine&lock questionnaire and a total of 41 Q-test. This questionnaire will be re-answered in the future to assess the impact of ADHES Project activities among the Spanish Psychiatrists. Results-" Of d00 psychiatrists, 330 (82,5%) completed the questionnaire. The distribution of site was 20.3% to acute psychiatric units, 65.8% to mental heath community centers, 8.2% long-stay psychiatric centers, and 5.7% others. 85% of the psychiatrists considered non-compliance with medication as the main reason for m-admission to a closed psychiatric ward. Nevertheless, an 82% of psychiatrists believe insufficient agenda in international meeting to compliment of treatment. Two thirds of psychiatrists estimated non-compliance of their schizophrenic patients after six months to between 25-75%. An 86% and 88% admitted that schizophrenic patient add worse to treatment than patients with depressive disorders and somatic chronic disease, reapectivdy Spanish psychiatrists considered themselves first responsible of the follow-up of compliance, before nurses and families. Disease insight was referred as the major factor for the non-adherence (it was consider as "very importanP' by 90% of psychiatrists). Conel~iom Similarly to literature data, the ADHES project results show that psychiatrists underestimate non-compliance in schizophrenic patients and points to increase focus and resources to improve adherence. Psychiatrists anticipate that improving non-adherence will significantly reduce the consequence of noncompliance and thus improve the long-term outcome of patients with schizophrenia.
•
Evaluation of the relationship between antipsychotics and hospitalization in bipolar disorder
C, Kozrna 1, M,RT, Rupnow 2 *, i University of South Carolina, Hea#h Services l"tesearch, Columbia, [IS.A.; 2Ja~ssen Medical Affairs, L.L.C., Outcomes iResear&, Titusoille, ~J.S.A.
Objeclive: To investigate the relationship between days of antipsychotic availabilityand hospitalization%r bipolar disorderpatients,
•
P2, Psychotic disorders and caztipsye#otics
Long-term clinical effectiveness of quelJapine in first-episode psychosis
L, Kopala 1, H, Millikan 2, D, Whitehorn 2, Q, Rui 2, H, Woodley 2, K.P. Good 2, i University of British Columbia, Ce~er for Complex
Brain Disorders, Department of Psychiatry, Vancouver, Canada; 2Dalhousie University, Department of Psychiatry, Halifax, Canada Purpose: The benefits of early diagnosis and optimal treatment of first-episode psychosis are well established, as are the benefits of second generation antipsychotic medications, However, neither dosing nor long-term clinical effectiveness of the atypical antipsychotic quetiapine have been described in this population. This study addresses these shortcomings by examining long-term clinical, cognitive and qualib/of life (QoL) outcomes, and dosing issues in a representative sample of patients with first-episode psychosis, Methods: This was a 2-year, open-label study of patients with schizophrenia spectrum disorder and first-episode psychosis. Clinical and cognitive data were collected every 3 months while the Wisconsin QoL index (W-QLI) data were collected at 6, 12 and 2d months. Statistical analysis used paired and unpaired t-tests. Resttl~: Thirty-nine patients (7 female, 32 male; mean age, 23.2 years) were enrolled, of whom, 21 patients completed the 2-year study The mean dose of quetiapine was 540 ms/day at Year 1, which increased to 605 mg/day at Year 2. The majority (26/39, 67%) of patients had been previously treated with an antipsychotic for a mean (SD) of 10.3 (7.2) weeks. At Year 2, quetiapine significantly irrproved mean scores for Positive and Negative Syndrome Subscale (baseline 66.6; Year 2, 40.3; p<0.0001), Global Assessment of Function (baseline, 39; Year 2, 74.7; p<0.0001), and Social and Occupational Function (baseline,, 48.9; Year 2, 78.1; p<0.0001). Furthermore, quetiapine treatment was associated with a significant improvement in mood, as assessed by the Calgary Depression Scale for Schizophrenia (baseline, 5.5; Year 2, 2.1; p=0.006). After 6 months' treatment, quefiapine significantly improved QoL (general satisfaction, psychological wellbeing, symptoms/outlook, activities of daily living [ADL], and weighted and unweighted W-QLI). With the exception of ADL, all aspects remained significant at Year 1; Year 2 data will be presented. All patients demonstrated an improvement in motor function over the tveo years as assessed by the Extrapyramidal Syndrome Rating Scale; improvements in akathisia were significant at Year 1 (p=0.047) and approached significance at Year 2 (p=0.057). Regarding cognitive function, patients showed a significant improvement in attention and executive function at Year 2 (p<0.05). Generally, quetiapine was wall tolerated: no patients required anticholinergics or beta blockers for extrapyramidal signs or symptoms (EPS), no glucose dysregulation was experienced and no case of diabetes was recorded. Moreover, quetiapine treatment was not associated with significant changes in cholesterol levels. Triglyceride levels increased slightly from baseline (1.4 mmol/L) to Year 1 (1.8 mmol/L); however there was no appreciable increase to Year 2 (1.9 mmol/L). C e n e l ~ i o m In patients with first-episode psychosis, quetiapine was effective in the treatment of positive and negative psychotic symptoms while improving various domains of cognitive function, and QoL. Importantly, quetiapine treatment did not result in drug-induced EPS; in fact, pre-existing abnormal motor function improved over time. Dosing stra~gies for this population will be described,
•
N
e
w
insights in the therapeutic adherence in schizophrenia
J. Qiner 1, M. Roca 2, F. Cafias 3, A. Rodriguez 4, I.M. Olivares 5, A. Rodr{guez-Morales 6, J.A. BurSn 6 *, G. Martinez-Junquera ~, A D H Spanish Group for the Study of Therapeutic Adherence in Schizophrenia r . iHo#pitai Unioersitario Yirgen &l IRoc{o,
Psy&iat,ry, Seuilla, Spain; 2Hospital Unioersitario Palma de MaEorca, Psychiatry, Palma de MaEorca, 5~ain; 3Hospital Rodr@uez Lafora, Psychiatry, Madrid, 5pain; ~IMPU, Psychiatry, Barcelona, @sin; JHospital Xeral Islas Cfes, Psychiatry, P]go, Spain; 6Ja~sen-Cilag, @ain, Medical Department, Madrid Spain; 7ADHES Project, Psychiatry, @ain, Spain Objective: To evaluate, the approach of Spanish psychiatrists to the non-adherence issue in the treatment of psychotic patients. This survey was the first initiative in the ADHES Project. This ambitious project aims to identify and measure the relevant variables that are involved in the compliance of schizophrenic patients. Methe& A multicenter e-questionnaire in a PDA platform as data enter tracking system, was issued to one tenth of Spanish Psychiatrists, from 1st of March to 31 st of May 2003. Psychiatrists screened the therapeutic compliance of schizophrenic patients using a nine&lock questionnaire and a total of 41 Q-test. This questionnaire will be re-answered in the future to assess the impact of ADHES Project activities among the Spanish Psychiatrists. Results-" Of d00 psychiatrists, 330 (82,5%) completed the questionnaire. The distribution of site was 20.3% to acute psychiatric units, 65.8% to mental heath community centers, 8.2% long-stay psychiatric centers, and 5.7% others. 85% of the psychiatrists considered non-compliance with medication as the main reason for m-admission to a closed psychiatric ward. Nevertheless, an 82% of psychiatrists believe insufficient agenda in international meeting to compliment of treatment. Two thirds of psychiatrists estimated non-compliance of their schizophrenic patients after six months to between 25-75%. An 86% and 88% admitted that schizophrenic patient add worse to treatment than patients with depressive disorders and somatic chronic disease, reapectivdy Spanish psychiatrists considered themselves first responsible of the follow-up of compliance, before nurses and families. Disease insight was referred as the major factor for the non-adherence (it was consider as "very importanP' by 90% of psychiatrists). Conel~iom Similarly to literature data, the ADHES project results show that psychiatrists underestimate non-compliance in schizophrenic patients and points to increase focus and resources to improve adherence. Psychiatrists anticipate that improving non-adherence will significantly reduce the consequence of noncompliance and thus improve the long-term outcome of patients with schizophrenia.
•
Evaluation of the relationship between antipsychotics and hospitalization in bipolar disorder
C, Kozrna 1, M,RT, Rupnow 2 *, i University of South Carolina, Hea#h Services l"tesearch, Columbia, [IS.A.; 2Ja~ssen Medical Affairs, L.L.C., Outcomes iResear&, Titusoille, ~J.S.A.
Objeclive: To investigate the relationship between days of antipsychotic availabilityand hospitalization%r bipolar disorderpatients,