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Subjective experiences of schizophrenic patients on atypical antipsychotic olanzapine and typical antipsychotic perphenazine
P.2 Psychotic disorders and antipsychotics date, all the behavioral models that do so, require previous drug administration (e.g., of DA agonists or NMDA antagonists). The LI model is the only behavioral model which does not rely on pharmacological means to elicit the behavioral index of antipsychotic activity.
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Subjective experiences of schizophrenic patients on atypical antipsychotic olanzapine and typical antipsychotic perphenazine
T. Szafrafiski, M. Jarema, M. Olajossy 1, W. Chrzanowski2, A. Araszkiewicz3, J. Landowski4, J. Rybakowski5, A. Bilikiewicz4, J. Bomba 6. Institute of Psychiatry and Neurology, Warsaw; I Medical
Academy Lublin; 2Medical Academy Biatystok, 3Medical Academy Bydgoszcz; 4Medical Academy Gdatisk; 5 Unioersity of Medical Sciences Poznah; 6Medical College of Jagiellonian University, Cracow, Poland Background: Patient's subjective interpretation of their medicated state is one of the factors related to quality of life and compliance in schizophrenia. It is postulated that new atypical antypsychotics improve patient's well being because of lack of relevant affective and motor side effects. The aim o f the present study was to investigate patient's subjective response to atypical and typical antipsychotic. Method: This was randomised, double-blind, multicenter trial of olanzapine (5-20 mg) versus perphenazine (8-40 mg) in patients with DSMIV diagnosis schizophrenia. Subjective experience were measured by Drug Attitude Inventory (DAI-30, Awad & Hogan), psychopathology by PANSS, and motor side-effects by Simpson-Angus and Barnes Akathisia Scale. Subjects were evaluated three times: at baseline, after first week of treatment with olanzapine/perphenazine and at the end of the study after 18 weeks. Results: Total number of 95 patients were randomised, 56 patients completed the DAI-30 at the end of the study. Patients who did not complete the protocol had more negative symptoms at baseline and after first week (Mann-Whithney p < 0.05), they also differed in DAI-30 score (more negative attitude) after first week of treatment (Marm-Whithney, p < 0.05). We analysed changes in the subjective attitude toward drug in 30 patients in olanzapine and 26 patients in perphenazine group. At baseline DAI-30 score was lower in olanzapine group than in perphenazine group (mean = 10.5 s.d. = 13.7 and mean = 14.7 s.d. = 13.7 respectively) but the difference was not statistically significant. After the first week of treatment DAI-30 score in olanzapine group improved (mean = 13.3 s.d.= 13.1) whereas remained the same in the perphenazine group (mean = 14.3, s.d. = 12.5, n.s.). At the end of the study DA1-30 score in olanzapine group was superior to perphenazine group (mean = 18.6, s.d. = 8.9 and mean = 17.2, s.d. = 9.9 respectively, n.s.).. Overall, during 18 weeks treatment, there was improvement of subjective attitude in olanzapine group (Friedman ANOVA p < 0.005) in contrast to perphenazine group (n.s.). At the end of the study motor side-effects measured by SimpsonAngus and Barnes Akathisia Scale were significantly less pronounced in olanzapine group (Mann-Whithney p < 0.05 and p < 0.01 respectively). Conclusions: Our findings must be interpreted with caution because of small sample size, and lack of DAI-30 scores of subjects who dropped out from the study. In this randomised, double-blind trial we found substantial improvement of subjective attitude to pharmacotherapy in the group of patients treated with new atypical antypsychotic olanzapine and not significant improvement in patients treated with classic antypsychotic perphenazine. This findings are in concordance with data which show improvement in patient's well being on atypical antypsychotics which might reduce non-compliance in schizophrenia.
This study was supported by research grant from EliLilly Poland
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$273
Atypical neuroleptics, speed of processing and overall clinical psychopathology in schizophrenia
A. Politis, P. Oulis, I. Hatzimanolis, E. Balli, G.N. Christodoulou, C.N. Stefanis. Athens Unio. Medical School, Dpt of Psychiatry, Eginition
Hospital, Vas. Sophias 72-74, Athens 11528, Greece Introduction: The theoretical model of automatic and controlled information processing assumes that patients with schizophrenia perform poorly when controlled processing loads are high. Previous studies of medication effects on information processing indicate that typical neuroleptics may improve automatic processing. (Serper R.M. 1990). Furthermore the administration of Ruff's selective attention test to medicated schizophrenics has shown that patients preserve automatic processing and sacrifice speed in favor of accuracy (Weiss M.K. 1996). In order to explore the relationship between automatic and controlled processing deficits and clinical psychopathology, and to compare responses of both to pharmacological treatment with atypical neuroleptics, schizophrenic patients were examined on and off medication. Material-Methods: The sample of the study was constituted by 26 inpatients with DSM-IV diagnosis of schizophrenia. All were right-handed with normal visual acuity. Mean age = 32.3 years (SD = 8.5), mean duration of illness was 8.6 years (SD = 7.8), mean years of education I 1.2 years (SD = 3.7), mean age of onset 23.7 (SD = 6.5). In terms of types of medication all subjects were treated with atypical neuroleptics (8 with risperidone, 7 with clozapine and 11 with olanzapine). Automatic and controlled information processing were measured using the Ruff's selective attention test. Clinical state was measured by the Positive and Negative Syndrome Scale (PANSS). Patients were tested twice, before the initiation of neuroleptic treatment, and six weeks later. It should be emphasized that l0 patients were drug naive and 16 patients underwent a wash-out period. Subjects' scores before and after treatment were compared by means of Wilcoxon test for related samples. The relation ship between automatic and controlled processing measures and clinical rating was measured by Spearman, correlation coefficient. All statistical tests were two- tailed. Results: Under neuroleptic medication patients speed performance improved significantly in both automatic detection (z = -4.059, p = .00) and controlled search (z = -3.470, p = 0.001) whereas accuracy increased in both types of processing (z = -2.141, p = 0.032) and (z = -2.051, p = 0.04). Furthermore, total speed improved significantly (z = -3.283, p = 0.001) as well as total accuracy (z = -2.156, p = 0.031). Under neuroleptic medication PANSS total scores improved significantly (z = -3.413, p = 0.001). However no statistically significant correlation were detected between PANSS's scores and Ruff's measures both before and after treatment. Conclusions: Our findings suggest that almost all subjects work carefully but slowly in both types of processing. Clinically, patients show significant improvement under treatment with atypical neuroleptics. Furthermore, the results of the present study indicate that short-term treatment with atypical rteuroleptics improve slowness in both automatic detection and controlled search but the latter are not correlated with overall clinical psychopathology. Thus overall severity of clinical psychopathology and speed processing deficits constitute distinct and independent dimensions in schizophrenia.
References [1] Serper R.M. et al (1990) Medication may be required for the development of automatic information processing in Schizophrenia. Psychiatry Research 32, 281-288. [2] Weiss M.K. (1996) A simple clinical assessment of anention in schizophrenia. Psychiatry Research 60, 147-154.
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Subjective experiences of schizophrenic patients on atypical antipsychotic olanzapine and typical antipsychotic perphenazine
T. Szafrafiski, M. Jarema, M. Olajossy 1, W. Chrzanowski2, A. Araszkiewicz3, J. Landowski4, J. Rybakowski5, A. Bilikiewicz4, J. Bomba 6. Institute of Psychiatry and Neurology, Warsaw; I Medical
Academy Lublin; 2Medical Academy Biatystok, 3Medical Academy Bydgoszcz; 4Medical Academy Gdatisk; 5 Unioersity of Medical Sciences Poznah; 6Medical College of Jagiellonian University, Cracow, Poland Background: Patient's subjective interpretation of their medicated state is one of the factors related to quality of life and compliance in schizophrenia. It is postulated that new atypical antypsychotics improve patient's well being because of lack of relevant affective and motor side effects. The aim o f the present study was to investigate patient's subjective response to atypical and typical antipsychotic. Method: This was randomised, double-blind, multicenter trial of olanzapine (5-20 mg) versus perphenazine (8-40 mg) in patients with DSMIV diagnosis schizophrenia. Subjective experience were measured by Drug Attitude Inventory (DAI-30, Awad & Hogan), psychopathology by PANSS, and motor side-effects by Simpson-Angus and Barnes Akathisia Scale. Subjects were evaluated three times: at baseline, after first week of treatment with olanzapine/perphenazine and at the end of the study after 18 weeks. Results: Total number of 95 patients were randomised, 56 patients completed the DAI-30 at the end of the study. Patients who did not complete the protocol had more negative symptoms at baseline and after first week (Mann-Whithney p < 0.05), they also differed in DAI-30 score (more negative attitude) after first week of treatment (Marm-Whithney, p < 0.05). We analysed changes in the subjective attitude toward drug in 30 patients in olanzapine and 26 patients in perphenazine group. At baseline DAI-30 score was lower in olanzapine group than in perphenazine group (mean = 10.5 s.d. = 13.7 and mean = 14.7 s.d. = 13.7 respectively) but the difference was not statistically significant. After the first week of treatment DAI-30 score in olanzapine group improved (mean = 13.3 s.d.= 13.1) whereas remained the same in the perphenazine group (mean = 14.3, s.d. = 12.5, n.s.). At the end of the study DA1-30 score in olanzapine group was superior to perphenazine group (mean = 18.6, s.d. = 8.9 and mean = 17.2, s.d. = 9.9 respectively, n.s.).. Overall, during 18 weeks treatment, there was improvement of subjective attitude in olanzapine group (Friedman ANOVA p < 0.005) in contrast to perphenazine group (n.s.). At the end of the study motor side-effects measured by SimpsonAngus and Barnes Akathisia Scale were significantly less pronounced in olanzapine group (Mann-Whithney p < 0.05 and p < 0.01 respectively). Conclusions: Our findings must be interpreted with caution because of small sample size, and lack of DAI-30 scores of subjects who dropped out from the study. In this randomised, double-blind trial we found substantial improvement of subjective attitude to pharmacotherapy in the group of patients treated with new atypical antypsychotic olanzapine and not significant improvement in patients treated with classic antypsychotic perphenazine. This findings are in concordance with data which show improvement in patient's well being on atypical antypsychotics which might reduce non-compliance in schizophrenia.
This study was supported by research grant from EliLilly Poland
•
$273
Atypical neuroleptics, speed of processing and overall clinical psychopathology in schizophrenia
A. Politis, P. Oulis, I. Hatzimanolis, E. Balli, G.N. Christodoulou, C.N. Stefanis. Athens Unio. Medical School, Dpt of Psychiatry, Eginition
Hospital, Vas. Sophias 72-74, Athens 11528, Greece Introduction: The theoretical model of automatic and controlled information processing assumes that patients with schizophrenia perform poorly when controlled processing loads are high. Previous studies of medication effects on information processing indicate that typical neuroleptics may improve automatic processing. (Serper R.M. 1990). Furthermore the administration of Ruff's selective attention test to medicated schizophrenics has shown that patients preserve automatic processing and sacrifice speed in favor of accuracy (Weiss M.K. 1996). In order to explore the relationship between automatic and controlled processing deficits and clinical psychopathology, and to compare responses of both to pharmacological treatment with atypical neuroleptics, schizophrenic patients were examined on and off medication. Material-Methods: The sample of the study was constituted by 26 inpatients with DSM-IV diagnosis of schizophrenia. All were right-handed with normal visual acuity. Mean age = 32.3 years (SD = 8.5), mean duration of illness was 8.6 years (SD = 7.8), mean years of education I 1.2 years (SD = 3.7), mean age of onset 23.7 (SD = 6.5). In terms of types of medication all subjects were treated with atypical neuroleptics (8 with risperidone, 7 with clozapine and 11 with olanzapine). Automatic and controlled information processing were measured using the Ruff's selective attention test. Clinical state was measured by the Positive and Negative Syndrome Scale (PANSS). Patients were tested twice, before the initiation of neuroleptic treatment, and six weeks later. It should be emphasized that l0 patients were drug naive and 16 patients underwent a wash-out period. Subjects' scores before and after treatment were compared by means of Wilcoxon test for related samples. The relation ship between automatic and controlled processing measures and clinical rating was measured by Spearman, correlation coefficient. All statistical tests were two- tailed. Results: Under neuroleptic medication patients speed performance improved significantly in both automatic detection (z = -4.059, p = .00) and controlled search (z = -3.470, p = 0.001) whereas accuracy increased in both types of processing (z = -2.141, p = 0.032) and (z = -2.051, p = 0.04). Furthermore, total speed improved significantly (z = -3.283, p = 0.001) as well as total accuracy (z = -2.156, p = 0.031). Under neuroleptic medication PANSS total scores improved significantly (z = -3.413, p = 0.001). However no statistically significant correlation were detected between PANSS's scores and Ruff's measures both before and after treatment. Conclusions: Our findings suggest that almost all subjects work carefully but slowly in both types of processing. Clinically, patients show significant improvement under treatment with atypical neuroleptics. Furthermore, the results of the present study indicate that short-term treatment with atypical rteuroleptics improve slowness in both automatic detection and controlled search but the latter are not correlated with overall clinical psychopathology. Thus overall severity of clinical psychopathology and speed processing deficits constitute distinct and independent dimensions in schizophrenia.
References [1] Serper R.M. et al (1990) Medication may be required for the development of automatic information processing in Schizophrenia. Psychiatry Research 32, 281-288. [2] Weiss M.K. (1996) A simple clinical assessment of anention in schizophrenia. Psychiatry Research 60, 147-154.