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S.01.02 Treating schizophrenic patients with OCD and anxiety
S165
Symposia
S.01 Add-on therapies in schizophrenia S.01.02 Treating schizophrenic patients with OCD and anxiety J. Zohar ° , Y. Sasson, E. Yuven-Wetzler. Chaim Sheba Medical Center, Division of Psychiatry, Tel Hashomer, Israel Until DSM-IV, schizophrenia was an exclusion criterion for OCD, and therefore our knowledge about this comorbidity is limited to data gathered after 1994. As many schizophrenic patients can differentiate the ego-dystonic obsessive compulsive symptoms that they perceive as originating from within themselves from the ego-syntonic delusions that they perceive as introduced to them from outside, epidemiological studies are possible. Since then it has been noted that as many as 15% of chronic schizophrenic patients also suffer from OCD. This increased prevalence of OCD in schizophrenia compared with that in the general population (2%) has raised intriguing questions regarding the association between OCD and schizophrenia. Since the presence of OCD in schizophrenia was found to predict a poor prognosis, it is important to focus on improving the treatment approach. For this subset of patients, treatment with a combination of antipsychotic and antiobsessive medication has a better outcome as compared to antipsychotic medication alone. The role of the second generation antipsychotics (SGA) in this specific cohort of patients needs to be studied more carefully, given their mixed serotonergic and dopaminergic profiles. So far, there have been no studies which examine the effect of SGA in patients with a ‘serotonergic component’, namely patients with schizophrenia and obsessive compulsive disorder versus patients with schizophrenia alone. Preliminary data from a study in which the effects of SGA were compared in schizoobsessive and schizophrenic patients indicate that this treatment option, although not suitable for all schizo-obsessive patients, may be beneficial in some cases. References [1] D. Denys, J. Zohar, H. Westenberg. The role of dopamine in obsessivecompulsive disorder: preclinical and clinical evidence. J Clin Psychiatry 2004; 65(Suppl 14): 11−17.
S.01.03 The treatment of post-psychotic depression S. Dollfus ° . Centre Hospitalier et Universitaire, Department of Psychiatry, Caen, France Because depression in schizophrenia has often been associated with suicide, diagnosis and treatment of post-psychotic depression are essential. Depression is known to occur during the course of schizophrenia. However, the symptoms of depression can overlap negative symptoms, extrapyramidal symptoms, dysphoria induced by neuroleptics, prodromes of psychotic relapse or acute distress reaction to life-events. Consequently, several therapeutic strategies can be considered. One can be the use of “atypical” antipsychotics.
Indeed, several controlled studies suggested a benefit for atypical antipsychotics in depressive symptoms in schizophrenia. In a previous study (Dollfus et al., 2005), we specifically tested an action of these drugs in postpsychotic depression in a multicentric, randomized, double-blind study. The aim of this study was to compare, the efficacy of olanzapine (5 to 15 mg/d) and risperidone (4 to 8 mg/d) in patients with a postpsychotic depression (DSMIV). The study was interrupted after 36 and 40 patients were included in olanzapine and risperidone arms respectively. Patients were randomized after 1 week of placebo if they presented MADRS scores 16 associated with positive PANSS scoresa 28. There were significant decreases of MADRS scores in both groups after the 2nd and the 8th week of treatment. These results showed that both treatments improved depressive symptoms in residual schizophrenic patients with depression. Several therapeutic ways should be considered in the treatment of post-psychotic depression. The choice in prescribing atypical antipsychotics will be discussed having in mind the use of antidepressant treatment as well. References [1] Dollfus et al., 2005. Olanzapine versus risperidone in the treatment of post-psychotic depression in schizophrenic patients. Schizophr Res. 78(2−3): 157−9. [2] Siris SG, 2000. Depression in schizophrenia: perspective in the era of “Atypical” antipsychotic agents. Am J Psychiatry 157(9): 1379–1389. [3] Whitehead C, et al., 2002. Antidepressants for people with both schizophrenia and depression. Cochrane Database Syst Rev 4(2): 1−40.
S.01.04 Psycho-education in management of schizophrenia C. H¨oschl1 ° , L. Motlova2 . 1 Prague Psychiatric Center, pav. 19, Prague 8, Czech Republic; 2 3rd Faculty of Medicine Charles University, Prague Psychiatric Center, Prague 8, Czech Republic Successful schizophrenia management should include interventions aimed at adherence improvement. Psychoeducation is designed to deliver information about the illness and its treatment. Based on positive responses of psychoeducation participants and promising results of our one-year prospective follow-up study on relapse prevention (Motlova et al., 2006) we consider psychoeducation as an inevitable part of complex schizophrenia treatment. Therefore we introduce comprehensive psychoeducational program that consists of individual psychoeducation (illness management), group sessions for life style improvement, family psychoeducation workshops and information technology aided relapse prevention program (ITAREPS). Illness management consists of basic psychoeducation with an emphasis on practical, everyday problems with medication adherence. Group psychoeducation for life-style improvement is a 6-week structured group program led by trained psychiatric nurses. Weight-management component is important as fear of weight gain on antipsychotic medication further complicates adherence (Weiden et al., 2004). Family psychoeducation is designed to help family to provide safe and lowstress environment necessary for the long-term treatment. The last
Symposia
S.01 Add-on therapies in schizophrenia S.01.02 Treating schizophrenic patients with OCD and anxiety J. Zohar ° , Y. Sasson, E. Yuven-Wetzler. Chaim Sheba Medical Center, Division of Psychiatry, Tel Hashomer, Israel Until DSM-IV, schizophrenia was an exclusion criterion for OCD, and therefore our knowledge about this comorbidity is limited to data gathered after 1994. As many schizophrenic patients can differentiate the ego-dystonic obsessive compulsive symptoms that they perceive as originating from within themselves from the ego-syntonic delusions that they perceive as introduced to them from outside, epidemiological studies are possible. Since then it has been noted that as many as 15% of chronic schizophrenic patients also suffer from OCD. This increased prevalence of OCD in schizophrenia compared with that in the general population (2%) has raised intriguing questions regarding the association between OCD and schizophrenia. Since the presence of OCD in schizophrenia was found to predict a poor prognosis, it is important to focus on improving the treatment approach. For this subset of patients, treatment with a combination of antipsychotic and antiobsessive medication has a better outcome as compared to antipsychotic medication alone. The role of the second generation antipsychotics (SGA) in this specific cohort of patients needs to be studied more carefully, given their mixed serotonergic and dopaminergic profiles. So far, there have been no studies which examine the effect of SGA in patients with a ‘serotonergic component’, namely patients with schizophrenia and obsessive compulsive disorder versus patients with schizophrenia alone. Preliminary data from a study in which the effects of SGA were compared in schizoobsessive and schizophrenic patients indicate that this treatment option, although not suitable for all schizo-obsessive patients, may be beneficial in some cases. References [1] D. Denys, J. Zohar, H. Westenberg. The role of dopamine in obsessivecompulsive disorder: preclinical and clinical evidence. J Clin Psychiatry 2004; 65(Suppl 14): 11−17.
S.01.03 The treatment of post-psychotic depression S. Dollfus ° . Centre Hospitalier et Universitaire, Department of Psychiatry, Caen, France Because depression in schizophrenia has often been associated with suicide, diagnosis and treatment of post-psychotic depression are essential. Depression is known to occur during the course of schizophrenia. However, the symptoms of depression can overlap negative symptoms, extrapyramidal symptoms, dysphoria induced by neuroleptics, prodromes of psychotic relapse or acute distress reaction to life-events. Consequently, several therapeutic strategies can be considered. One can be the use of “atypical” antipsychotics.
Indeed, several controlled studies suggested a benefit for atypical antipsychotics in depressive symptoms in schizophrenia. In a previous study (Dollfus et al., 2005), we specifically tested an action of these drugs in postpsychotic depression in a multicentric, randomized, double-blind study. The aim of this study was to compare, the efficacy of olanzapine (5 to 15 mg/d) and risperidone (4 to 8 mg/d) in patients with a postpsychotic depression (DSMIV). The study was interrupted after 36 and 40 patients were included in olanzapine and risperidone arms respectively. Patients were randomized after 1 week of placebo if they presented MADRS scores 16 associated with positive PANSS scoresa 28. There were significant decreases of MADRS scores in both groups after the 2nd and the 8th week of treatment. These results showed that both treatments improved depressive symptoms in residual schizophrenic patients with depression. Several therapeutic ways should be considered in the treatment of post-psychotic depression. The choice in prescribing atypical antipsychotics will be discussed having in mind the use of antidepressant treatment as well. References [1] Dollfus et al., 2005. Olanzapine versus risperidone in the treatment of post-psychotic depression in schizophrenic patients. Schizophr Res. 78(2−3): 157−9. [2] Siris SG, 2000. Depression in schizophrenia: perspective in the era of “Atypical” antipsychotic agents. Am J Psychiatry 157(9): 1379–1389. [3] Whitehead C, et al., 2002. Antidepressants for people with both schizophrenia and depression. Cochrane Database Syst Rev 4(2): 1−40.
S.01.04 Psycho-education in management of schizophrenia C. H¨oschl1 ° , L. Motlova2 . 1 Prague Psychiatric Center, pav. 19, Prague 8, Czech Republic; 2 3rd Faculty of Medicine Charles University, Prague Psychiatric Center, Prague 8, Czech Republic Successful schizophrenia management should include interventions aimed at adherence improvement. Psychoeducation is designed to deliver information about the illness and its treatment. Based on positive responses of psychoeducation participants and promising results of our one-year prospective follow-up study on relapse prevention (Motlova et al., 2006) we consider psychoeducation as an inevitable part of complex schizophrenia treatment. Therefore we introduce comprehensive psychoeducational program that consists of individual psychoeducation (illness management), group sessions for life style improvement, family psychoeducation workshops and information technology aided relapse prevention program (ITAREPS). Illness management consists of basic psychoeducation with an emphasis on practical, everyday problems with medication adherence. Group psychoeducation for life-style improvement is a 6-week structured group program led by trained psychiatric nurses. Weight-management component is important as fear of weight gain on antipsychotic medication further complicates adherence (Weiden et al., 2004). Family psychoeducation is designed to help family to provide safe and lowstress environment necessary for the long-term treatment. The last