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Teaching schizophrenic patients about their depot neuroleptic medication
P Poster Presentations
172 ratory dyskine sia using computer analysis of spirograph data monitored by both a Somniprobe nasal thermis tor and a strain-gauge. By clinical examination. 23 patients showing irregular respiratory rate. tachypnea. or grunting suspected respiratory dyskinesia. These 23 patient s were then examined by nasal therm ister for air flow. and strain gauge for thoracic movemen t. The coefficient of variation (CV) in distance from peak to peak of respiratory movements over three minutes was measur ed for each patie nt. For 7 patients, their CVs were > 2 SO greater than the mean CV found among IO normal controls. The number of bursts of air flow (thermistor) was subtracted from the number of respiratory movements (strain gauge) as an est imate of desynchronization or obstruction. For 3 patients. this difference was >2 SD than the mean difference found among 10 norm al controls. All 3 of these "desy nchronized" or "obstructive" patients were among the seven who met "irregularity" criteria as above . The prevalence of respiratory dyskinesia was 2.8% (7 out of 248 subjects surveyed) and 13% amo ng a TD population. Respiratory dyski nesia was classified into two subtypes : the obstructive type with irregular respiratory movement and the irregular respiratory type with or with out apnea. A computer analysis of spirog raph data will be useful for the investigation of respiratory dyskinesia.
I p-15-sl
The Incidence of Neutropenia and AgranUlocytosis in Patients Treated with Clozapine in the UK and Ireland
K. Atkin I . F. Kendall I , H. Freeman 2. H. Lieberman '. D. O'S ullivan I Pharmacovigilance Department. Sandoz Pharmaceuticals, Frimley; UK; 2 Green College, Oxford; 3 Department of Psychiatry & Neuroscience, Albert Einstein Collegeof Medicine. New York
I.
Clozapi ne is of proven efficacy in treatment-resistant schizophrenia. Concerns regarding the possibi lity of neutropenia and agranulocytosis have determ ined that a national coo rdinated monitorin g service ensure s that the provision of clozapine is depend ent on recent satisfactory haemarological results. Th is study docum ent s the occurrence of neutropenia (defined as a neutrophi l count < 1.5 x 109/1 and agra nulocytosis (neutrophil count < 0.5 x 109 /1), and identifies predisposing risk factors. as determin ed by the central patient database of the Ctozaril" . Patie nt Monitoring Service. A retrospective analysis was made of the data on 6316 patient s receiving clozap ine over a 4 112 year period . During this time. 182 (2.88%) of the patients developed neutropenia and 48 patients with agranuloc ytosis died (0.03%) . The peak inciden ce of both disorders occurred in the first 6-18 weeks of treatment. but beyond one year there was a statistically significant (p < 0.(05) decrea sed incidence in both neutropenia and agranu locytosis (from 2.3% and 0.7%. to 0.7% and 0.07%, respectively ). The incidence of agranulocytosis beyond one year of the same order of magnitude as that found with phenothiazines without mandatory blood monitoring. African and Afro-C aribbeans had a higher frequen cy of the less severe co ndition of neutro pen ia. but no increase risk of agranul ocytosis. Patient s over 50 years were at slightly higher risk of agranulocytosis. Dose was not a risk factor for either dyscrasia. Thi s centralised database provides a clea rly-defined assessment of haemarological risk assoc iated with cJozapine use, in a large co hort of patie nts over a prol onged period. Haematological mon itoring via the Clozartl'? Patient Mo nitoring Se rvice has been shown to keep this risk to an acceptable minimum . bearing in mind the benefits of clozap ine in patients with treatment-resistant schizophrenia.
adequate non-specific support for somatic co ndition of our patients was provided . We observed improvement in all patients and there did not occur any fatality amon g them . We also observed an improvement in the psychotic symptoms of these patients. The duration of their stay at the ICU was 17 days in average. The range of the ECT appl ied was between 2- 12. We consider ECT, if properl y indicated and applied . to be a safe and efficacious trea tment modality in NMS patients.
IP-15-10.I Considerations about Neuroleptics' Use: Past, Present and Future A. Moroni. N. Kaufma nn. A. Za nobio. U.O. Psychiatry, Ospedale
Niguarda, Milano, ltalia The Authors express some considerations about the meaning of the discovery and the introduction of the use of neuroleptics in the psychiatric practice: in the Fifties the first experiences leveled . after several decades. the psychiatric therapy method to the general medicine filling a gap present at the moment. But in th present days the psychopharmachology seems to search that action selectivity pursued and ascribed to the other classes of non-psychiatric medicines. The Authors end with some ipothesis on the more and less near future of the neuroleptics psych opharmacology.
IP-15-11 ITeaching Schizophrenic Patients abouttheir DepotNeuroleptic Medication I , G. Turpin 2, T. Nielson 3. I Department of Psychiatry. University of Sheffield, UK; 2 Department of Psychology, University of Sheffield, UK; 3 Community Health Sheffield NHS Trust, Sheffield. UK
M. Peet
This was a pilot study aimed at evaluating differe nt educational modal ities. Th irty-one out-patients with a OSM III R diagnosis of schizophrenia were allocated at random to a control group receiving no education. or to groups educated using combinations of written information, videotape. and a role-play aimed at leaching patients how to obtain information from doctors about their medication. Attitudes towards and knowledge of medication were rated before and at one and three month s after education. At baseline, the more literate patients knew more abo ut their trea tment. the more intellectually impaired and those with lower self-esteem had a Jess favourable attitude towards their medication . Answers to individual questions showed substantial m isunderstanding about treatment. (Thus, 18 (58%) patients thought their injections were an antidepressant, 8 (26 %) thought that hearing voices is a common side-effect, 22 (7 1%) did not know what tardive dyskinesia is, and 9 (29%) believed they had no choice about whether to take medication). At three month s after education. only the group given the role-play showed a significantly sustained impro vement in knowled ge about their medication . Satisfaction with level of knowledge increased from 32% to 6 1% after education. even thoug h objective gains in knowledge were small and inconsistent . Attitude towards med ication was not alte red by education.
IP-15-12 1 Effects of Clozapine on Cognitive Performance in Schizophrenia, A Clinical Study
S. Totic, D. Marinko vic, B. Acirnovic, T. Babinski, V.R. Paunovic.
Institute of Psychiatry, CCS, Belgrade. Yugoslavia
Ip.15-s l Treatment of the Neuroleptic Malignant Syndrome by Electroconvulsive Therapy Dagm ar Seifertova. Psychiatric Center, Prague. Czech Rep.
Neu roleptic Malignant Syndrome (NMS) is life-threatening complication of neuroleptic treatment. Mon ality rate of cases without specific treatment was repo ned to reach 2 1%. Sug gestions were made on the probable safety and efficacy of electro convulsive treatment (ECT). Thi s is a report on the treatment of NMS patients at the Intensive Care Unit (lC U). During the last three years ECT was used as the main treatment modality in II patients that had been referred to ICU because of their treatment emergent NMS. They represented 78.6% of all NMS cases treated at the Unit. EeT were administred after discontinuation of neuroleptic treatment and
It has been reponed that schizophrenia is associated with multiple cog nitive defic its. The treatment with typical neurolept ics may also impair cognitive function in schizo phrenia. Due to the specific pharmacolog ical profile, it could be expected that clozapine, an atypical antipsych otic drug, has no such effects on cognition. Th is study evaluates the effects of clozapine treatment 011 cog nitive functioning in 22 male schizophrenic in-patients. The neuro psychological assess men t was perform ed at the beginning of the treatm ent and 6 weeks after. Statistical evaluation demonstrated a significant improvement, under clozapine treatment. on tests measuring soma aspects of attention. response speed and verbal fluency. This improvement may be due to the different pharmacodynamic actions of clozapine and typical neuroleptic drugs.
172 ratory dyskine sia using computer analysis of spirograph data monitored by both a Somniprobe nasal thermis tor and a strain-gauge. By clinical examination. 23 patients showing irregular respiratory rate. tachypnea. or grunting suspected respiratory dyskinesia. These 23 patient s were then examined by nasal therm ister for air flow. and strain gauge for thoracic movemen t. The coefficient of variation (CV) in distance from peak to peak of respiratory movements over three minutes was measur ed for each patie nt. For 7 patients, their CVs were > 2 SO greater than the mean CV found among IO normal controls. The number of bursts of air flow (thermistor) was subtracted from the number of respiratory movements (strain gauge) as an est imate of desynchronization or obstruction. For 3 patients. this difference was >2 SD than the mean difference found among 10 norm al controls. All 3 of these "desy nchronized" or "obstructive" patients were among the seven who met "irregularity" criteria as above . The prevalence of respiratory dyskinesia was 2.8% (7 out of 248 subjects surveyed) and 13% amo ng a TD population. Respiratory dyski nesia was classified into two subtypes : the obstructive type with irregular respiratory movement and the irregular respiratory type with or with out apnea. A computer analysis of spirog raph data will be useful for the investigation of respiratory dyskinesia.
I p-15-sl
The Incidence of Neutropenia and AgranUlocytosis in Patients Treated with Clozapine in the UK and Ireland
K. Atkin I . F. Kendall I , H. Freeman 2. H. Lieberman '. D. O'S ullivan I Pharmacovigilance Department. Sandoz Pharmaceuticals, Frimley; UK; 2 Green College, Oxford; 3 Department of Psychiatry & Neuroscience, Albert Einstein Collegeof Medicine. New York
I.
Clozapi ne is of proven efficacy in treatment-resistant schizophrenia. Concerns regarding the possibi lity of neutropenia and agranulocytosis have determ ined that a national coo rdinated monitorin g service ensure s that the provision of clozapine is depend ent on recent satisfactory haemarological results. Th is study docum ent s the occurrence of neutropenia (defined as a neutrophi l count < 1.5 x 109/1 and agra nulocytosis (neutrophil count < 0.5 x 109 /1), and identifies predisposing risk factors. as determin ed by the central patient database of the Ctozaril" . Patie nt Monitoring Service. A retrospective analysis was made of the data on 6316 patient s receiving clozap ine over a 4 112 year period . During this time. 182 (2.88%) of the patients developed neutropenia and 48 patients with agranuloc ytosis died (0.03%) . The peak inciden ce of both disorders occurred in the first 6-18 weeks of treatment. but beyond one year there was a statistically significant (p < 0.(05) decrea sed incidence in both neutropenia and agranu locytosis (from 2.3% and 0.7%. to 0.7% and 0.07%, respectively ). The incidence of agranulocytosis beyond one year of the same order of magnitude as that found with phenothiazines without mandatory blood monitoring. African and Afro-C aribbeans had a higher frequen cy of the less severe co ndition of neutro pen ia. but no increase risk of agranul ocytosis. Patient s over 50 years were at slightly higher risk of agranulocytosis. Dose was not a risk factor for either dyscrasia. Thi s centralised database provides a clea rly-defined assessment of haemarological risk assoc iated with cJozapine use, in a large co hort of patie nts over a prol onged period. Haematological mon itoring via the Clozartl'? Patient Mo nitoring Se rvice has been shown to keep this risk to an acceptable minimum . bearing in mind the benefits of clozap ine in patients with treatment-resistant schizophrenia.
adequate non-specific support for somatic co ndition of our patients was provided . We observed improvement in all patients and there did not occur any fatality amon g them . We also observed an improvement in the psychotic symptoms of these patients. The duration of their stay at the ICU was 17 days in average. The range of the ECT appl ied was between 2- 12. We consider ECT, if properl y indicated and applied . to be a safe and efficacious trea tment modality in NMS patients.
IP-15-10.I Considerations about Neuroleptics' Use: Past, Present and Future A. Moroni. N. Kaufma nn. A. Za nobio. U.O. Psychiatry, Ospedale
Niguarda, Milano, ltalia The Authors express some considerations about the meaning of the discovery and the introduction of the use of neuroleptics in the psychiatric practice: in the Fifties the first experiences leveled . after several decades. the psychiatric therapy method to the general medicine filling a gap present at the moment. But in th present days the psychopharmachology seems to search that action selectivity pursued and ascribed to the other classes of non-psychiatric medicines. The Authors end with some ipothesis on the more and less near future of the neuroleptics psych opharmacology.
IP-15-11 ITeaching Schizophrenic Patients abouttheir DepotNeuroleptic Medication I , G. Turpin 2, T. Nielson 3. I Department of Psychiatry. University of Sheffield, UK; 2 Department of Psychology, University of Sheffield, UK; 3 Community Health Sheffield NHS Trust, Sheffield. UK
M. Peet
This was a pilot study aimed at evaluating differe nt educational modal ities. Th irty-one out-patients with a OSM III R diagnosis of schizophrenia were allocated at random to a control group receiving no education. or to groups educated using combinations of written information, videotape. and a role-play aimed at leaching patients how to obtain information from doctors about their medication. Attitudes towards and knowledge of medication were rated before and at one and three month s after education. At baseline, the more literate patients knew more abo ut their trea tment. the more intellectually impaired and those with lower self-esteem had a Jess favourable attitude towards their medication . Answers to individual questions showed substantial m isunderstanding about treatment. (Thus, 18 (58%) patients thought their injections were an antidepressant, 8 (26 %) thought that hearing voices is a common side-effect, 22 (7 1%) did not know what tardive dyskinesia is, and 9 (29%) believed they had no choice about whether to take medication). At three month s after education. only the group given the role-play showed a significantly sustained impro vement in knowled ge about their medication . Satisfaction with level of knowledge increased from 32% to 6 1% after education. even thoug h objective gains in knowledge were small and inconsistent . Attitude towards med ication was not alte red by education.
IP-15-12 1 Effects of Clozapine on Cognitive Performance in Schizophrenia, A Clinical Study
S. Totic, D. Marinko vic, B. Acirnovic, T. Babinski, V.R. Paunovic.
Institute of Psychiatry, CCS, Belgrade. Yugoslavia
Ip.15-s l Treatment of the Neuroleptic Malignant Syndrome by Electroconvulsive Therapy Dagm ar Seifertova. Psychiatric Center, Prague. Czech Rep.
Neu roleptic Malignant Syndrome (NMS) is life-threatening complication of neuroleptic treatment. Mon ality rate of cases without specific treatment was repo ned to reach 2 1%. Sug gestions were made on the probable safety and efficacy of electro convulsive treatment (ECT). Thi s is a report on the treatment of NMS patients at the Intensive Care Unit (lC U). During the last three years ECT was used as the main treatment modality in II patients that had been referred to ICU because of their treatment emergent NMS. They represented 78.6% of all NMS cases treated at the Unit. EeT were administred after discontinuation of neuroleptic treatment and
It has been reponed that schizophrenia is associated with multiple cog nitive defic its. The treatment with typical neurolept ics may also impair cognitive function in schizo phrenia. Due to the specific pharmacolog ical profile, it could be expected that clozapine, an atypical antipsych otic drug, has no such effects on cognition. Th is study evaluates the effects of clozapine treatment 011 cog nitive functioning in 22 male schizophrenic in-patients. The neuro psychological assess men t was perform ed at the beginning of the treatm ent and 6 weeks after. Statistical evaluation demonstrated a significant improvement, under clozapine treatment. on tests measuring soma aspects of attention. response speed and verbal fluency. This improvement may be due to the different pharmacodynamic actions of clozapine and typical neuroleptic drugs.