Nasal
Spray May Improve Cognition, Memory Loss
Source:
Daily Mail (UK)
Doctors have successfully used a nasal spray based on
insulin to improve memory for the first time. Men and women
who used the spray remembered twice as many test words after
two months than those using a dummy spray. They also felt
happier, fitter and more self-confident according to the
report by Roger Dobson.
This
treatment may eventually be used by people with
schizophrenia to improve the cognitive deficits that are a
common symptom of the disease. New research has shown that
verbal memory deficits may be a predictor of childhood-onset
schizophrenia, and poor verbal memory has been cited in
literature as a specific cognitive loss in schiziophrenia
patients.
Read a
full news article about the spray:
Intranasal Insulin May Alleviate Memory Loss in Elderly and
Alzheimer's Patients
(http://www.pslgroup.com/dg/23e1f2.htm).
New
Medicare Rules May Affect You
New
Medicare drug-benefit rules in the USA may impact You - The
Government is Seeking Public Feedback.
The
Medicare Modernization Act, enacted last year and taking
effect in January 2006, represents a fundamental change in
the 40-year-old entitlement program. It creates a $ 400
billion prescription drug benefit for elderly people and
some people with disabilities and gives private insurers a
huge new role. For the first time, private-sector drug plans
will administer the benefit through a competitive model
One
big issue for the mental health field is the way the benefit
will treat people who quality for both Medicare and
Medicaid. Called "dual eligibles," these beneficiaries are
thought to number about 6.4 million. Up to 40 percent are
estimated to have a serious mental illness such as bipolar
disorder or schizophrenia. Currently, only Medicaid carries
a prescription drug benefit for them.
Dually
eligible beneficiaries will see their drug coverage shift
from Medicaid to Medicare over time.
The
National Alliance for the Mentally Ill (NAMI), worries that
dually eligible beneficiaries could find their drug access
more limited than it is now. This could happen if the
formularies allowed under Medicare are more restrictive than
the drug coverage that beneficiaries could obtain through
Medicaid, or if the Medicare formularies fail to include a
drug that has been covered through Medicaid.
"NAMI
would like to see a continuity-of-care requirement" that
would prohibit the new Medicare plans from denying people
effective medication as they make the transition from
Medicaid, Andrew Sperling, NAMI's director of federal
legislation stated recently.
"At
the very least, the regulations must ... 'grandfather in'
this coverage," states a letter from NAMI to CMS
Administrator Mark B. McClellan, M.D., Ph.D.
The
notice currently does not contain such a requirement. NAMI
will work to see that such a requirement is added and will
work to ensure that the new regulations allow the greatest
access to the broadest range of treatments for mental
illness.
Another big issue for the field involves the way that drug
formularies will be devised for the new Medicare plans. The
regulations and law allow for health insurers to use
Pharmacy and Therapeutics Committees to design their
formularies and coverage plans. The committees' composition
and authority, and the requirement that they must be
independent and free of conflict of interest, are discussed
in the notice.
But
the regulations don't require the committees to conduct
their business in "an open, transparent process with public
meetings," according to NAMI. "We'd like to see openness and
transparency in the process," Sperling said.
A
highlight in the regulations, Sperling said, is CMS's
decision to name the U.S. Pharmacopeial Convention, Inc.
(USP), of Rockville, Md., to develop model guidelines to be
used as a framework for insurers as they design their
prescription drug formularies. The guidelines will include
therapeutic categories and classes of drugs to be covered.
For
more information, see
Centers for Medicare & Medicaid Services, at:
www.cms.hhs.gov/medicarereform
Childhood Schizophrenia and Other Brain Disorders - a public
report by the Detroit Free Press
This
month, The Detroit Free Press is starting a three part
series on Children in Crisis: Mental Health,". It is an
important, but disturbing report - and is valuable reading
for families, support groups, and especially public policy
makers.
The
series is available at
www.freep.com/specials
So
far, Michigan has settled for a sort of mental health
shuffle board. Some kids are lucky enough to have their
problems spotted and be referred for managed mental health
care. A great many, though, are far less fortunate. They
either go un-cared for or are shuffled into juvenile
detention, foster care or jails -- all overburdened systems
that are ill-equipped to diagnose, let alone care for,
children with schizophrenia, bipolar disorder or depression.
Much
of the problem is that Michigan is like a dog chasing its
tail on this issue. If the state had a method, which it
incredibly does not, of accurately counting each child in
need, legislators might understand the consequences of
inadequately funding the Department of Community Health.
They might even see the danger in the shortage of state-run
psychiatric hospitals for young people. Once there were six,
now only one.
Therapy for Major Disorders Via Telephone Shows Promise
Although treatments for many psychiatric disorders are
much improved in the last fifty years, the majority of
sufferers still struggle to find something that consistently
works for them. For example, in the estimation of Dr. Allen
Roses, an academic geneticist from Duke University, only 60%
of schizophrenia patients treated with medication respond
(Source:
"Glaxo chief - our drugs do not work on most patients."
The Independent, Dec 8 2003. No details were given as to the
type of medication administered, the length of time meds
were taken, or other therapies concurrent with medication).
If medication alone is still largely hit-or-miss, than it's
more important than ever to coordinate community health
resources and make all kinds of therapies available. A
recent study has brought one such therapy to light - the
possibility of recieving counseling sessions by telephone.
In the
journal article (published in the Journal of American
Medicine), the recovery rates for clinically depressed
patients taking anti-depressant drugs were significantly
improved by telephone counseling sessions during the week.
600
subjects taking antidepressants were randomly assigned to
recieve one of three treatment plans: a normal standard of
care (a prescription, instructions, and encouragment to use
it properly), telephone management (two phone calls with
advice and support concerning the prescription, or phone
therapy (up to eight telephone sessions with trained
counselors providing targeted behavioral therapy). The
results from the telephone therapy group were very
encouraging - after 18 months, 80% of these subjects
reported that their symptoms were "much improved." 66% of
subjects recieving just telephone management reported
similar improvement, while only 55% of those just receiving
medication said the same.
Although it is not clear how many people might benefit from
telephone therapy - the study subjects were all
independently motivated to seek treatment, and were
medication compliant - primary investigator Dr. Gregory E.
Simon is excited by the potential in the results.
"This
represents an important change in the way we approach
treatment," Dr. Simon said, "not only using the phone, but
being persistent, proactive, reaching out to people and
finding them where they are. Depression is defined by
discouragement; very often they're not going to come to
you."
Telephone therapy could have many implications, among them
improving medication compliance, supplementing existing
medication regimens, and extending the reach of mental
health services. Stigma is a huge barrier to therapy,
particularly in small or rural communities where remaining
anonymous is a challenge. Telephone therapy might offer a
more secure, less stigmatizing alternative to people seekign
support.
Regular follow-up with phone sessions might also help
prevent tragedies such as suicide. According to Joanne
Stern, who gave a workshop on suicide prevention (on behalf
of SPAN-CA) at the NAMI California annual convention in
August, good follow-up care is a key component of
prevention. In her experience as a suicide-hotline staffer,
suicidal feelings are generally lessened through talk. In
her own words, "Talk is the breath of life to someone who's
drowning."
For
the full article, see
"New Therapy on Depression FInds Phone Is Effective"
(Aug 25 2004) in the New York Times
(http://www.nytimes.com).
For
more information on the specific efficacy of psychotherapy
in treating schizophrenia, see the following Psychiatric
Times article:
"Medication-Psychotherapy Combination Most Effective for
Schizophrenia" (published in Psychiatric Times, May
1998, Vol XV, Issue 5).
For
some
supplemental treatments that may be helpful for
schizophrenia when combined with medication therapy, see
Other Treatments on the schizophrenia.com website
(http://www.schizophrenia.com/treatments.htm).
Successful Therapy for Cognitive Deficits
According to new research published in this month's Archives
of General Psychiatry, cognitive rehabilitation can lead to
major improvements for patients with stable schizophrenia.
This is promising news, given the inability of most
anti-psychotic medications to consistently or dramatically
improve the negative, or social/cognitive, symptoms of
schizophrenia.
According to the research team, cognitive therapy is most
beneficial to patients with controlled symptoms and reduced
relapse risk, but with lingering social and cognitive
deficits.
In
their study, the team examined the potential benefits of two
types of cognitive therapy with a pool of 121
symptomatically-stable schizophrenia/schizoaffective
disorder patients. The subjects recieved either "cognitive
enhancement therapy," an approach that combines
neurocognitive training (via computer programs) with social
cognitive group exercises, or "enriched supportive therapy,"
which uses coping strategies and patient education to
improve individual illness management.
After
12 months, results showed that the Cognitive Enhancement
Therapy group had major improvements in processing speed and
neurocognition (esp. improved verbal memory and some
problem-solving skills), and modest improvements in
cognitive style, social cognition, and social adjustment.
This improvement trend continued over an additional 12
months.
Patients recieving enriched supportive therapy did not show
such a dramatic cognitive advance, although there were still
measurable neurocognitive and behavioral improvements.
The
researchers optimistically concluded: "[t]he cognitive
disabilities of schizophrenia do not need to be the
persistent deficits described in numerous naturalistic,
longitudinal studies. Instead, many of these disabilities
are capable of improvement after adequate exposure to
cognitive rehabilitation."
For
the full story, see "Cognitive rehabilitation shows robust
benefits for schizophrenics" Sept 10, 2004. Available at
http://www.psychiatrysource.com
Read the published research online:
"Cognitive Enhancement Therapy for Schizophrenia: Effects of
a 2-year Randomized Trial on Cognition and Behavior"
(Arch Gen Psychiatry, 2004;60:866-876).
Cognitive therapy has shown much promise as a form of
psychotherapy for schizophrenia patients. See the articles
below for details:
1.
Cognitive Therapy for Schizophrenia.
(http://www.psychologyinfo.com/schizophrenia/cognitive.htm).
2.
Cognitive-Enhancement Therapy - an overview of the basic
principles, and how it can be effective in treating
schizophrenia. (http://planneohio.org/overview.htm)
3.
Computer-Assisted Cognitive Rehabilitation Reduces Negative
Symptoms in the Severely Mentally Ill.
(http://www.braintrain.com/captains_log/schizophrenia_treament.htm).
Job
Success Predictors for Schizophrenia Patients
A team from Indiana University-Purdue University
Indianapolis suggests that the job performance of
schizophrenia patients may be more affected by the extent of
their cognitive impairments than on the availability of
vocational rehabilitation.
The
team interviewed 112 schizophrenia patients enrolled in
employment programs, and tested them for verbal learning and
memory skills, attention, information processing ability,
and executive functioning.
After
four months, results showed that patients with higher
neuropsychological profile scores had better work behaviors,
including work habits, personal presentation, work quality,
social skills, cooperativeness, number of hours worked per
week, and wages earned.
Jovier
Evans, primary investigator for the team, emphasizes that
both cognitive ability and vocational support resources
essentially contribute to the job success of schizophrenia
patients.
"Vocational services seem best equipped to help people get
jobs, but do not necessarily help clients in the performance
of their duties on the jobs," note Evans et al in the
journal Schizophrenia Research.
For
the full article, see
"Cognitive measures predict schizophrenic job success"
(Sep 3 2004) at http://www.psychiatrysource.com
For more information about returning to work after a
diagnosis of schizophrenia, please see the following links:
1)
Can a person with schizophrenia return to work/school? -
information and suggestions for a smooth transition
2)
Work-related resources for people with disabilities - on
the schizophrenia.com website, under the Recovery and
Resources section. Once on the page, scroll down to the
Resources for Returning to Work section.
Past Abuse May Be a Common Factor in Psychiatric Disorders
A UK research team reported in the British Journal of
Psychiatry (2004:185:220-226) that psychosis is more common
among people who have a significant number of traumatizing
events in their past. The findings were based on a data
analysis the 2nd British National Survey of Psychiatric
Morbidity.
The
team concluded that such negative social events may play a
role in the development of psychotic symptoms. In reality,
it's difficult to determine cause and effect - perhaps the
characteristics of psychosis bring about traumatizing events
as a result, or perhaps people with psychosis report
hallucinations they experience as real events.
According to the data, the most common trauma experienced by
those with psychosis was sexual abuse, followed by being
institutionalized during childhood, running away from home,
being homeless, or being taken into local authority care.
However, as there does seem to be some correlation between
social trauma and psychosis, healthcare providers should put
an emphasis on cognitive-behavioral therapy for these
patients to address such early trauma events.
For
the full article, please see
"Psychosis emerges in people subjected to victimizing
events" (Sept 3 2004) at www.psychiatrysource.com
Poor
Verbal Memory Linked to Pediatric Schizophrenia
Recent
research from the National Public Health Institute in
Finland suggests that childhood-onset schizophrenia appears
to be linked to more specific cognitive deficits than
adult-onset, which involves more generalized deficits.
Children with early-onset schizophrenia had poorer verbal
memory function (according to testing with the California
Verbal Learning Test, the Wechsler Memory Scale, and the
Weschler Adult Intelligence Scalle) than older people with
schizophrenia. The study included a total of 237
schizophrenia patients, ranging in age from 13 to 44 years.
The
specific verbal deficits included poorer word recall, poor
ability to group words into appropriate categories, and
poorer word recognition. However, overal working memory
performance (general, not specifically verbal) and IQ
measures did not differ significantly based on age of onset.
Researchers also noted that although people who have lived
with schizophrenia longer have a more marked cognitive
decline overall, this still did not offset the fact that
children with schizophrenia performed more poorly on
verbal-memory tasks specifically.
The
article, recently published in the British Journal of
Psychiatry (2004:185:215-219) concludes: "Verbal memory
deficits – known to be highly associated with functional
outcome in schizophrenia – should particularly be taken into
account in the neuropsychological evaluation and efforts at
remediation in patients with early-onset disorder."
For
the full article, see
"Age at schizophrenia onset linked to verbal memory
deficits" Sept 8, 2004. Psychiatry Source
(http://www.psychiatrysource.com).
Read the published study online - available at
http://bjp.rcpsych.org/cgi/content/abstract/185/3/215
For
further research on this topic, see the following:
1)
Neurocognitive Testing of Patients with Schizophrenia - Why?
(available at http://www.astrazeneca.no).
2)
Neuropsychological deficits in children associated with
increased familial risk for schizophrenia. Available at
http://www.pubmed.com
3)
Childhood developmental abnormalities in schizophrenia:
evidence from high-risk studies. Available at
http://www.pubmed.com
Family
Affected by SZ Raises Hope, Awareness, and $$ for Research
Brandon Staglin had a bright and promising future. As a
child, he skipped grades at school, had a perfect GPA,
stellar test scores, and a high IQ. As a national merit
scholar and with aspirations of being an astronautical
engineer at age 18, his descent into schizophrenia was
sudden and stunning to him and to those who knew him. Within
his first week of showing symptoms, he was picked up by the
police for wandering around the town of Lafayette and put in
a mental institution.
From
the day his parents rushed home from a business trip in
Paris to collect their son, the family started down a
tumultuous and frightening road together.
"We
thought there was a huge mistake," says Brandon's mother,
Shari Staglin. "There was confusion, fear. We took him home
from the hospital, and I remember him saying there was
something wrong with his bed. He kept doing this unusual
action with his hand."
Garen
Staglin, Brandon's father, agreed. "He couldn't function. He
was hearing voices that were tormenting him. He couldn't get
rid of incoherent thoughts."
After
his initial break in 1990, it appeared that Brandon might
beat the odds of his illness, and go on to fulfill all his
previous potential. He returned to Dartmouth and graduated
in 1993 as an anthropology/engineering science major.
Working first as a marketing analyst and then as an
astronautical engineer, he planned to get his master's
degree in engineering.
In
1996, he had his second major break.
"It
was a new manifestation of my disease," said Brandon. "I
would hallucinate pain. It started in my upper left
forehead. Eventually I was experiencing stabbing pain in my
stomach. The pain was so bad that I couldn't walk. I
couldn't eat. It felt like a spear was going into my
stomach."
Brandon checked into an out-patient psychiatric hospital at
UCSF, and battled with his illness. Many times he had to
pull himself back from the brink of suicide.
From
watching and participating in their son's struggle, the
Staglin's were moved to make a major contribution to the
schizophrenia community. Through connections in venture
capitalism, they initiated the Music Festival for Mental
Health in 1994. Most of the $90,000 raised from the event
was given to the National Alliance for Research on
Schizophrenia and Depression.
Today,
the Staglins remain in contact with leading schizophrenia
researchers, and have created an international council of
scientists on the topic of schizophrenia. Their newest
project is to offer a $250,000 grant to an young
up-and-coming researcher (under the age of 45) who has a
promising breakthrough project planned around schizophrenia.
Other
projects funded by the Staglins include an endowed
professorship at UCLA, and a pilot program at UCSF that uses
software programs to provide intensive therapy training to
schizophrenia patients.
Besides their generosity and activism, the Staglins have
done much to break down the barriers of stigma. "They have
decreased the stigma of mental illness," says Craig Van
Dyke, chairman of the UCSF Dept. of Psychiatry. "In telling
their story, they are giving other families hope."
The
Staglin's continue to stress that they do what they do for
their son. Today, 34 year-old Brandon is stable on a regimen
of medications. He manages his own illness, setting his
watch timer to remind him of his meds, and works
independently as a writer and a web designer. But he is
still troubled by common banes that affect many
schizophrenia patients - emotional flatness that isn't
helped by medication, apathy where there once was energy.
"I'm
not the dynamo I once was, but I'm feeling warmth again,"
Brandon says. "I wrote a poem called 'To Live on The Moon.'
It's about the sun rising in my mind, about my starting to
feel passion again, about starting to feel ambition."
Why
did I love to live on the moon?
Cold, remote, desolate
Yet magnificent, claimed one whom I followed
So easy it is to take life hard
So natural to be lost
So long as you don't realize it
Some part of me was talent latent
And I don't think it is now
The sun's limb warms my eyelids
Thaws my hands
Without ice, I'll need new material
The ground is still slippery
How to get up and run
God, can I even remember?
For
the full story, please see
"A family's journey to madness and back: Son's schizophrenia
spurs parents to raise millions for research" (Sept 7
2004). San Francisco Chronicle (http://www.sfgate.com).
To
read
other stories of hope and success from people with
schizophrenia, please see "Success Stories" on the
Schizophrenia.com website
(http://www.schizophrenia.com/success.html)
Interview with Psychotic Mice Scientists
As we've covered before in our Daily Schizophrenia Blog,
the recent development of genetically alterred laboratory
mice that develop schizophrenia may offer insights into the
cause of schizophrenia. Here is a brief interview with one
of the researchers involved:
Q:
What makes mice psychotic other than the looming presence of
an
unfriendly feline.
A: In
this case the rodents have genetically engineered mutations
in two genes.
Q: How
do they know which genes to tweak?
A: The
mutations are the same as those found in a Canadian family
with a history of schizophrenia. The genes concerned are
called NPAS1 and NPAS3.
Q: Who
is doing this?
A: Dr
Steven McKnight and a team from the University of Texas
Southwestern Medical Centre and the Children's Hospital
Medical Centre in Cincinnati.
Q:
What happened?
A: The
mice without a working copy of the genes displayed erratic
behaviour. When introduced to other mice, instead of
climbing over them and sniffing them, they began darting
about, trying to avoid them.
Q: So?
A:
When the University of Texas research team examined the
brains of the psychotic mice, they found an abnormally low
level of a protein called reelin,
important in embryonic development of the brain and brain
cell signalling.
Q:
What has all this to do with schizophrenia?
A:
Studies of people who died with schizophrenia have found
reduced levels
of reelin in their brains.
Q: So
now schizophrenics know they have something in common with
psychotic mice. How can that possibly help them?
A: The
link may help pharmaceutical companies come up with better
therapies. Schizophrenia is a condition that affects around
24 million people worldwide. They experience disrupted
thoughts and behaviour and sometimes delusions.
Source: An excerpt from a story in The Herald, Glasgow,
Ireland
The
Safety and Effectiveness of Long-Acting Risperdal
Safety
and Efficacy of Long-Acting Risperidone in Schizophrenia: A
12-Week, Multicenter, Open-Label Study in Stable Patients
Switched From Typical and Atypical Oral Antipsychotics.
Lindenmayer JP, Eerdekens E, Berry SA, Eerdekens M.
J Clin Psychiatry. 2004 Aug;65(8):1084-1089.
Pharmaceutical companies have recently been touting
long-acting injectable medications as the answer to
maintaining reliable, consistent levels of medication and
helping with preventing relapse through medication
compliance in those with schizophrenia. Risperidone has been
the first such atypical medication available in such a
long-acting injectable form. This study aimed to look at the
safety and effectiveness of this type of medication in a
clinically stable group of people with schizophrenia. The
study involved a 12 week open label, multicenter,
exploratory clinical trial, where they collected data from a
from clinics, hospitals, and physicians' offices.
Participants with schizophrenia entered a 4 week period
where they continued to receive the same dose of their
current oral medication (which was Haldol, Seroquel or
Zyprexa). They received 25mg of long acting injectable
risperodone at baseline and then every 2 weeks, with
allowance for the doctor to change the dose upto a certain
point. Safety measurements were based on the patient’s
self-report, clinical observation, lab reports and physical
exams. They measured the effectiveness of the medication
based on symptom checklists (PANSS & CGI).
The
authors report that long-acting risperidone was well
tolerated. Of the 141 patients who completed the study, the
most frequently reported adverse events were insomnia (16%),
headache (15%), psychosis (11%), and agitation (11%). There
was a slight increase in body weight (0.4 kg). 5 patients
experienced adverse effects that resulted in the
discontinuation of the study and a few experienced serious
side effects that that included psychosis and agitation. The
authors do not report any significant lab abnormalities or
ECG results. They also report that the severities of certain
side effects (extrapyramidal symptoms) were reduced during
treatment and there were improvements in symptoms of
schizophrenia that started during the 4th week and continued
through the 12-week period.
Limitations of this study are the open label and lack of a
control group. This means that the raters were not blind to
the medication the patients were on, and this could have
biased their ratings of symptoms. Also, since this study
allowed other medications to be used at the same time, it is
difficult to parse out the unique contributions of the
injectable risperidone while the flexible dose approach used
could have also biased the results.
The
authors have disclosed financial support from Lilly, Pfizer,
Janssen, AstraZeneca, Bristol Myers-Squibb, Repligan &
Johnson & Johnson (see article for details
Click here to link to PubMed for this article
Doctor's Recommendations for Monitoring SZ Patient Health
Physical health monitoring of patients with schizophrenia.
Marder
SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM,
Kane JM, Lieberman JA, Schooler NR, Covell N, Stroup S,
Weissman EM, Wirshing DA, Hall CS, Pogach L, Pi-Sunyer X,
Bigger JT Jr, Friedman A, Kleinberg D, Yevich SJ, Davis B,
Shon S.
Am J Psychiatry. 2004 Aug;161(8):1334-49.
Individuals with schizophrenia seem to have a 20% shorter
life expectancy than the population and have more
vulnerability to illnesses such as diabetes, coronary heart
disease, hypertension, and emphysema. This could be because
of lifestyle choices (eg poor dietary habits, obesity, high
rates of smoking, alcohol and street drugs) and side effects
from certain antipsychotic medications (prolactin elevation,
cataract formation, movement disorders, sexual dysfunction,
weight gain, onset of diabetes, increases in plasma lipids,
and abnormal ECGs).
A
conference was organized by some who believed that the
health needs of people with schizophrenia who take
antipsychotic medications are not adequately addressed by
clinicians in specialty mental health programs or in primary
care settings. This Mount Sinai Conference (2002) aimed to
develop recommendations for the systematic health monitoring
of individuals with schizophrenia for whom antipsychotic
medication is prescribed. This was based on a consensus
meeting of leading psychiatric and other medical experts who
evaluated the existing literature and developed
recommendations for physical health monitoring of patients
with schizophrenia. They reviewed the following areas: 1)
weight gain and obesity; 2) diabetes; 3) hyperlipidemia; 4)
prolongation of the QT interval on the ECG; 5) prolactin
elevation and related sexual side effects; 6) extrapyramidal
side effects, akathisia, and tardive dyskinesia; 7)
cataracts; and 8) myocarditis.
Their
consensus recommendations were as follows: regular
monitoring of body mass index, plasma glucose level, lipid
profiles, and signs of prolactin elevation or sexual
dysfunction. They recommend that information from monitoring
should guide the selection of antipsychotic agents. Specific
recommendations were also made for cardiac monitoring of
patients who receive medications associated with QT interval
prolongation, including thioridazine, mesoridazine, and
ziprasidone, and for monitoring for signs of myocarditis in
patients treated with clozapine. They suggested that
patients who receive both older and newer antipsychotic
medications should be examined for extrapyramidal symptoms
and tardive dyskinesia and receive regular visual
examinations.
It is
worthwhile to retrieve this article and look through their
specific recommendations (Table 1 in the article). This can
help with being well informed during clinical appointments
with doctors – especially since the conference recommended
that mental health care providers be involved in performing
physical health monitoring since not all patients receive
such physical health monitoring in their primary care
settings.
The
consensus meeting on which this article is based did not
receive financial support from the pharmaceutical industry.
However, individual conference participants have disclosed
support from various pharmaceutical companies. See the
article for full list.
Click here to link to PubMed for this article
Low
Dose vs High Dose Haldol for First-Episode Schizophrenia
Oosthuizen P, Emsley R, Turner HJ, Keyter N. A randomized,
controlled comparison of the efficacy and tolerability of
low and high doses of haloperidol in the treatment of
first-episode psychosis The International Journal of
Neuropsychopharmacology (2004), 7:125–131
This
study was conducted to determine which of two doses of
haloperidol (Haldol) would be more effective for patients
who are new to schizophrenia. In America, we are quick to go
to second generation antipsychotics like Risperdal or
Zyprexa, but outside of the US, Haldol is still used
frequently because of its cost effectiveness and its high
potency. People often stay away from Haldol because of the
greater risk for side effects like tardive dyskinesia (a
movement disorder) and other long term side effects. Also,
since Haldol is older and off patent, it is not marketed and
can sometimes be forgotten. There are some who argue that
the new antipsychotics are only marginal improvements and
therefore we are quick to ignore Haldol. Anyways, regardless
of the debate, these authors wanted to know if a higher dose
of Haldol was better to give or if it would be just as
effective but more likely to give side effects.
The
authors chose to compare a 2mg per day of Haldol group
versus an 8 mg per day group. They came up with those doses
based on previous data that suggested that 8 mg was a
threshold dose for the initiation of side effects. The
authors ultimately found that 2mg and 8mg were equally
effective but that the 8mg group did have some higher side
effects. One side effect was an increase in prolactin (a
hormone that is involved in production of breast milk and in
growing breast tissue.) They also showed that both groups
had movement disorders (called EPS or parkinsonian movments)
but that 8mg was worse than 2mg. They also thought that the
2mg did marginally better on negative symptoms than did the
8mg group.
Overall, this study is interesting because in many
situations it is worthwhile, though debatable, to consider
starting with Haldol first when someone has new symptoms
requiring treatment with an antipsychotic. While it is
probably better to try a 2nd generation antipsychotic first
when available one can see treatment effects from Haldol. It
would be better based on these data to start at 2mg per day
than a higher dose though individuals vary such that it may
be necessary to start at 5mg daily or higher doses if the
psychotic symptoms don’t remit. If you or someone you know
is on Haldol, you should not consider changing the dose
based on this study but if you have questions you can ask
your doctor.
This
study was supported by the Medical Research Council of South
Africa.
Click here to link to the article on Pubmed
