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- Eberhard, Jonas, et al.
(författare)
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Remission in schizophrenia: analysis in a naturalistic setting.
- 2009
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Ingår i: Comprehensive Psychiatry. - : Elsevier BV. - 0010-440X .- 1532-8384. ; 50:3, s. 200-208
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the recently defined Positive and Negative Syndrome Scale for Schizophrenia remission criteria in a naturalistic setting of psychotic patients; to identify causal factors that change remission status; and to validate the criteria against global indices of illness, cognitive functions, and social outcome. METHODS: This was a longitudinal naturalistic study of 162 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders (mean illness duration, 11 years) and treated with risperidone at study entry. Symptoms, drug treatment, cognitive function, and social outcome were measured at baseline and annually for 5 years. Remission was constructed retrospectively with only indirect data on stability over time. RESULTS: At study entry, 40% of the patients with schizophrenia were in symptomatic remission, stabilizing between 55% and 60% after a few years. The need for hospitalization became less frequent over time; initially 31%, dropping to 7% by years 4 and 5. Many patients went in and out of remission. Remission was strongly associated with global indices of illness, with intact insight and with social outcome (except work/studies) but not with cognition or medication. CONCLUSIONS: In spite of certain weaknesses of the study, we may conclude that current definition of remission is primarily a symptomatic measure, covering a subset of symptoms, some of which are not schizophrenia-specific. Although the definition may be clinically relevant, we must be aware of the risk that the connotation of the word could induce too much focus on symptom control.
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| 5. |
- Eberhard, Jonas, et al.
(författare)
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Prolactin level during 5 years of risperidone treatment in patients with psychotic disorders
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 115:4, s. 268-276
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate prolactin levels and related side effects in 128 men and 90 women initially treated with risperidone. Method: Patients initially treated with risperidone were followed over 5 years, during which 45% were switched to other antipsychotic drugs. Results: Initially, prolactin levels were fivefold the norm in women, and threefold in men. Diagnosis did not affect the prolactin level if adjustment for sex, current age, and age at onset of psychosis was applied. Prolactin levels did not correlate significantly neither with any Positive and Negative Symptom Scale item or subscale, nor with side effects. Drugs other than risperidone were not associated with high prolactin levels. For patients on continuous monotherapy risperidone treatment, there was a marked linear reduction of prolactin level over all 5 years. Conclusion: Risperidone induces a higher prolactin elevation than other atypical antipsychotics, but the effect adapts over time. Prolactin was not associated with expected side effects (e.g. sexual, mental, or weight gain).
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| 6. |
- Levander, Sten, et al.
(författare)
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Clinical decision-making during 5 years of antipsychotic treatment
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 17-26
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Explore how clinicians select drug treatment based on symptoms, side effects and patient factors, including patient participation in the process, and the association between these factors and attitudes towards drugs. Method: A cohort of 166 patients initially treated with risperidone was followed with yearly assessments over 5 years. At the end of the study, 101 patients were evaluated of whom 58 were still treated with risperidone. Results: More women than men remained in the study, and on the initial medication. The most common reason for medication switch was lack of efficacy. Clinicians and patients agreed well in their global ratings of medication effects and side effects. Robust associations between switch decisions and patient characteristics including symptoms and side effects could not be identified. The effects of switches were rated as better by the clinicians than by the patients. Negative drug attitudes were associated with pronounced positive symptoms (threshold effect), whereas the corresponding association with 'lack of judgment and insight' was linear over the whole range. Conclusion: The decision-making process appears to have many unknown components, and may benefit from more active patient involvement by using structured clinician and patient rating scales for monitoring the treatment. Such shared decision-making may improve compliance.
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| 7. |
- Levander, Sten, et al.
(författare)
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Costs of schizophrenia during five years
- 2007
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Ingår i: Schizophrenia Bulletin. - : Oxford University Press (OUP). - 1745-1701 .- 0586-7614. ; 33:2, s. 485-485
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Konferensbidrag (refereegranskat)
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| 8. |
- Levander, Sten, et al.
(författare)
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Nicotine use and its correlates in patients with psychosis
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 27-32
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine nicotine use and its correlates among psychotic patients. Method: Longitudinal naturalistic study of 176 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders, and treated with risperidone at study entry. Levels of nicotine use (smoking, snuffing) were measured along with other relevant ratings and measurements (symptoms, drug treatment, side effects, weight, cognitive functions and outcome) at baseline and once yearly for 5 years. Results: Nicotine use was twice as common as in the general population. Only few nicotine users had started after onset of psychoses. We could not find any differences among nicotine users and non-users in diagnosis, symptoms, side effects, weight, cognitive functions, personality and outcome, cross-sectionally and longitudinally, ruling against the 'self-medication' hypothesis. Conclusion: A parsimonious interpretation of the findings is that patients suffering from psychosis fail to desist from nicotine rather than experience significant positive effects of the usage.
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| 9. |
- Lindstrom, E, et al.
(författare)
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Costs of schizophrenia during five years
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 1600-0447 .- 0001-690X. ; 116:S435, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the direct and Indirect costs in a cohort of 225 risperidone-treated patients with schizophrenia followed up annually during 5 years. Method: Data on costs for medication, hospitalization, sheltered living and productivity losses, as well as degree of social isolation, were collected. Results: The direct costs were dominated by hospitalization and sheltered living expenses, while drug costs only represented 7% of the direct costs. Indirect costs represented 43% of the total costs during the 5 years. About 12% worked full-time, and 12% worked part-time, implying large productivity losses. As a consequence of the national mental health care reform, a substantial shift of costs from hospital care to sheltered living took place on the national level, but the reduction of hospital days for the study patients over time was much larger suggesting that the switch from first to second generation compounds was therapeutically successful. A high degree of social isolation was seen, with more than 20% being completely without social contacts and 30% seeing friends/relatives less often than once a week. Conclusion: The economic costs of schizophrenia are high and driven by the need for assisted living and hospitalizations, together with productivity losses. In addition, the intangible costs, such as social contacts, are also high.
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| 10. |
- Lindström, Eva, et al.
(författare)
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Five-year follow-up during antipsychotic treatment : efficacy, safety, functional and social outcome
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 5-16
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Explore the long-term course of schizophrenia and related disorders. Method: Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. Results: Stable symptomatology and side effects were observed. Clinician GAF scores were 55-61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked fulltime. One in four had no social contacts except with staff. Eight patients died during the 5 years. Conclusion: The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment.
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