Combining depot antipsychotic with an assertive monitoring programme for treating first-episode schizophrenia in a resource-constrained setting.

Aim: To assess the feasibility and effectiveness of depot antipsychotic (flupenthixol decanoate) combined with an assertive monitoring programme (AMP) in first-episode schizophrenia.

Methods: This was a prospective, non-comparative, longitudinal study conducted over 12 months assessing patient acceptance, adherence, outcome in domains of psychopathology, functionality and quality of life, and tolerability.

Results: Of 207 participants, 149 (72%) completed 12 months of treatment.

Assessing the efficacy of a modified assertive community-based treatment programme in a developing country.

Background: A number of recently published randomized controlled trials conducted in developed countries have reported no advantage for assertive interventions over standard care models. One possible explanation could be that so-called "standard care" has become more comprehensive in recent years, incorporating some of the salient aspects of assertive models in its modus operandi. Our study represents the first randomised controlled trial assessing the effect of a modified assertive treatment service on readmission rates and other measures of outcome in a developing country.

Pathways to inpatient mental health care among people with schizophrenia spectrum disorders in South Africa.

Objective: This study examined service utilization patterns and pathways to specialist mental health services among individuals with schizophrenia spectrum disorders in the Western Cape, South Africa, an area that has undergone deinstitutionalization since the mid-1990s.

Methods: Individuals who were consecutively admitted to any of the three psychiatric hospitals in the Western Cape from February 2007 to January 2008 were interviewed. Data on demographic characteristics, psychiatric history, service utilization, and pathways to care were gathered from service users, their relatives or associates, and hospital files.

Changes in erythrocyte membrane fatty acids during a clinical trial of eicosapentaenoic acid (EPA) supplementation in schizophrenia.

In a previously reported double-blind, placebo-controlled trial of eicosapentaenoic acid (EPA) as supplemental treatment in 40 patients with schizophrenia, we found significant improvement in symptoms as measured by the Positive and Negative Syndrome Scale (PANSS) compared to placebo (Emsley et al. 2002). Here we report changes in fatty acid composition of erythrocyte membranes in the same sample (n = 16 in each group).

The revolving door phenomenon in psychiatry: comparing low-frequency and high-frequency users of psychiatric inpatient services in a developing country.

Introduction: Deinstitutionalization has led to a dramatic reduction of inpatient beds and subsequent increase in pressure on available beds. Another consequence of deinstitutionalization has been the phenomenon of the revolving door patient; high-frequency users (HFUs) admitted to hospital repeatedly, remaining well for only short periods of time. The purpose of the study was to determine factors that contribute to HFU of inpatient psychiatric services by schizophrenia and schizo-affective disorder subjects in a developing country with a view to understanding this phenomenon better.

Mass murders: implications for mental health professionals.

In this article, we attempt to uncover whether mass murders (the killing of multiple victims in single events) are preventable acts, the extent to which they are contributed to by biological and psychological factors, the notion that they are inextricably linked to mental illness, the role of the media, and what lessons can be learned by mental health professionals.

Crisis discharges and readmission risk in acute psychiatric male inpatients.

Background: Severe pressures on beds in psychiatric services have led to the implementation of an early ("crisis") discharge policy in the Western Cape, South Africa. The study examined the effect of this policy and length of hospital stay (LOS) on readmission rates in one psychiatric hospital in South Africa.

Methods: Discharge summaries of adult male patients (n = 438) admitted to Stikland Psychiatric Hospital during 2004 were retrospectively examined.

Pathways to care and treatment delays in first and multi episode psychosis. Findings from a developing country.

Background: In contrast to findings from the developed world where general practitioners and mental health professionals are central in first episode psychosis pathways, studies from Africa have found GPs to play a less prominent role with other help providers such as traditional healers being more important.

Methods: We compared pathways to care, treatment delays and gender differences in patients with first versus multi episode psychosis.

Results: Private sector GPs were first contacts in first episode patients in as many as 38% of patients and were significantly more likely to be the first contact (odds ratio = 4.

Measuring anxiety in patients with schizophrenia.

This study describes the prevalence and distribution of anxiety symptomatology and anxiety disorders in a sample of hospitalized patients with schizophrenia, the estimated level of agreement between a clinician diagnostic measure and anxiety symptom status measures, and their internal consistency based on the average interitem correlations. Seventy inpatients receiving treatment for schizophrenia were assessed before discharge using a face-to-face diagnostic interview and structured questionnaires, namely the Mini International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale, the Spielberger Anxiety Inventory, and the Stein Generalized Anxiety Disorder (GAD) Scale. About a quarter of patients met criteria for an anxiety disorder, with GAD and social phobia occurring most commonly.

Remission in first-episode psychosis: predictor variables and symptom improvement patterns.

Background: Previous attempts to identify clinically useful predictors of treatment outcome in schizophrenia have been hampered by methodological inconsistencies, including a lack of standardized outcome measures. Recently proposed operationally defined criteria for remission provide an opportunity to readdress this topic.

Method: We applied the remission criteria to a sample of 57 subjects with first-episode psychosis (DSM-IV schizophrenia, schizoaffective disorder, or schizophreniform disorder), treated according to a fixed protocol in a prospective study.

The relationships between depression and remission in first-episode psychosis.

This study assessed changes in depressive symptoms over time in 57 patients with first-episode psychosis, and investigated the relationships of these symptoms during the acute psychotic episode and the post-psychotic period with treatment outcome. Assessment instruments included the Calgary Depression Scale (CDS) and the Positive and Negative Syndrome Scale (PANSS). For the evaluation of treatment outcome, recently proposed operational remission criteria were used.

The effects of eicosapentaenoic acid in tardive dyskinesia: a randomized, placebo-controlled trial.

Objective: Worldwide, conventional antipsychotic medication continues to be used extensively, and tardive dyskinesia (TD) remains a serious complication. The primary objective of the present study was to compare the efficacy of EPA versus placebo in reducing symptoms of TD.

Method: This was a 12-week, double-blinded, randomized study of ethyl-EPA 2g/day versus placebo as supplemental medication, in patients with schizophrenia or schizoaffective disorder, with established TD.

Neurological abnormalities in first-episode schizophrenia: temporal stability and clinical and outcome correlates.

Objective: Neurological abnormalities in subjects with schizophrenia have been regarded as diagnostically non-specific and non-localising. This study assessed the temporal stability of neurological abnormalities in subjects with first-episode schizophrenia over the course of 12 months. We also examined their relationships with psychiatric symptoms, medication effects and treatment outcome.

Effects of quetiapine and haloperidol on body mass index and glycaemic control: a long-term, randomized, controlled trial.

The topic of antipsychotic-induced weight-gain and its relationship to glucose metabolism is under-studied. We evaluated the long-term effects of a new-generation antipsychotic, quetiapine and a conventional antipsychotic, haloperidol on body mass index (BMI) and glycaemic control in patients with schizophrenia previously treated with conventional antipsychotics. Forty-five clinically stable patients with schizophrenia participated in this randomized, investigator-blinded, parallel-group comparison of flexible doses of quetiapine and haloperidol treatment over 52 wk.

A single-blind, randomized trial comparing quetiapine and haloperidol in the treatment of tardive dyskinesia.

Background: While the atypical antipsychotics should ultimately reduce the prevalence of tardive dyskinesia, it is likely to remain a significant clinical problem for a long time to come. No strategy has clearly emerged as the treatment of choice for tardive dyskinesia. Atypical antipsychotics have reduced propensities for producing acute extrapyramidal symptoms (EPS) and possibly tardive dyskinesia and may be effective in treating patients with established tardive dyskinesia.

Evidence-based pharmacotherapy of schizophrenia.

The introduction of the new-generation antipsychotics has changed the way we treat patients with schizophrenia. This article reviews these agents, focusing mainly on the published randomized controlled trials and meta-analyses in which the new-generation antipsychotics are compared with placebo, conventional antipsychotics or with one another. Agents included are risperidone, olanzapine, quetiapine, ziprasidone, sertindole, amisulpride and aripiprazole.

A randomized, controlled comparison of the efficacy and tolerability of low and high doses of haloperidol in the treatment of first-episode psychosis.

While haloperidol is still widely used in the treatment of psychoses, the optimal daily dose remains a topic of controversy, particularly in first-episode psychosis. Previous studies have suggested that doses as low as 2 mg/d may be effective, whereas others have indicated superiority for higher over lower doses. This double-blinded, randomized controlled study compared the efficacy and tolerability of 2 vs.

Clinical potential of omega-3 fatty acids in the treatment of schizophrenia.

The phospholipids in the neuronal membranes of the brain are rich in highly unsaturated essential fatty acids (EFAs). It has been hypothesised that abnormalities of phospholipid metabolism are present in patients with schizophrenia and that the EFAs omega-3 polyunsaturated fatty acids, and eicosapentaenoic acid (EPA) in particular, may have a role in treating this illness. Considerable preclinical and clinical evidence provides support for this proposal.

Incidence of tardive dyskinesia in first-episode psychosis patients treated with low-dose haloperidol.

Background: Previous studies suggest that the risk of tardive dyskinesia is increased with higher doses of conventional antipsychotics. This study evaluates the 12-month incidence of tardive dyskinesia in subjects with first-episode psychosis who were treated with very low doses of haloperidol.

Method: Fifty-seven subjects with first-episode psychosis and a DSM-IV diagnosis of schizophreniform disorder, schizophrenia, or schizoaffective disorder were treated according to a fixed protocol with a mean dose of haloperidol of 1.

Linking posttraumatic stress disorder and psychosis: a look at epidemiology, phenomenology, and treatment.

Several recent studies have provided direct evidence for the link between posttraumatic stress disorder (PTSD) and psychosis. Patients with psychotic disorders are known to be at a higher risk of traumatization and PTSD. Additionally, preclinical and clinical data suggest that the effects of trauma exposure on neural networks may provide a common diathesis for disorders like PTSD and schizophrenia.

The new and evolving pharmacotherapy of schizophrenia.

Based on the evidence presented here, the following tentative conclusions can be drawn. Atypical antipsychotics (except amisulpride) have shown superiority over placebo in acute schizophrenia. Compared with conventional antipsychotics, they are at least as effective.

Depressive symptoms at baseline predict fewer negative symptoms at follow-up in patients with first-episode schizophrenia.

There is uncertainty regarding the prognostic value of depressive symptoms in schizophrenia, having previously been associated with both favourable and poor outcome. This study investigated the relationship between baseline depressive symptoms and treatment outcome at 6, 12 and 24 weeks in 80 subjects with first-episode schizophrenia or schizophreniform disorder in terms of PANSS total and subscale score changes. No significant association was found between baseline PANSS depression factor scores and PANSS total and subscore changes.