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The adequacy of pharmaceutical treatment of schizophrenia in Quebec varies with age, but is not influenced by sex or neighbourhood deprivation.

https://arctichealth.org/en/permalink/ahliterature107816
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Publication Type
Article
Date
Aug-2013
Author
Frederieke M Brouwers
Josiane Courteau
Jean-Pierre Grégoire
Jocelyne Moisan
Sophie Lauzier
Alain Lesage
Marie-Josée Fleury
Alain Vanasse
Author Affiliation
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
Source
Can J Psychiatry. 2013 Aug;58(8):456-65
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antipsychotic Agents - therapeutic use
Cohort Studies
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Quebec - epidemiology
Residence Characteristics - statistics & numerical data
Schizophrenia - drug therapy - epidemiology
Sex Factors
Socioeconomic Factors
Young Adult
Abstract
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
PubMed ID
23972107 View in PubMed
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Antipsychotic drug--a study of the prescription pattern in a total sample of patients with a schizophrenic syndrome in one catchment area in the county of Uppland, Sweden, in 1991.

https://arctichealth.org/en/permalink/ahliterature210433
Source
Int Clin Psychopharmacol. 1996 Dec;11(4):241-6
Publication Type
Article
Date
Dec-1996
Author
E. Lindström
B. Widerlöv
L. von Knorring
Author Affiliation
Department of Psychiatry, University Hospital, Uppsala, Sweden.
Source
Int Clin Psychopharmacol. 1996 Dec;11(4):241-6
Date
Dec-1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antipsychotic Agents - therapeutic use
Drug Prescriptions - statistics & numerical data
Female
Humans
Male
Middle Aged
Schizophrenia - drug therapy - epidemiology
Sweden - epidemiology
Abstract
In a total population of patients with a schizophrenic syndrome, the amount of antipsychotic drugs during a defined period was studied. Doses of antipsychotics were higher in males than in females, low to moderate in most patients, and decreased with the duration of illness. There was a significant negative correlation between antipsychotic dose and age at first admission. Compulsory treatment as well as the use of depot preparations were equally common in both sexes. In patients who had been compulsorily admitted, significantly higher doses of antipsychotics were used. The amount of antipsychotics prescribed to a single patient was best explained by the presence or absence of hallucinations and loose associations.
PubMed ID
9031990 View in PubMed
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Antipsychotic drug treatment in the prodromal phase of schizophrenia.

https://arctichealth.org/en/permalink/ahliterature189535
Source
Am J Psychiatry. 2002 Jul;159(7):1230-2
Publication Type
Article
Date
Jul-2002
Author
Tyrone D Cannon
Matti O Huttunen
Minna Dahlström
Ilkka Larmo
Pirkko Räsänen
Alo Juriloo
Author Affiliation
Department of Psychology, University of California-Los Angeles, 1285 Franz Hall, Los Angeles, CA 90095, USA. cannon@psych.ucla.edu
Source
Am J Psychiatry. 2002 Jul;159(7):1230-2
Date
Jul-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - administration & dosage - therapeutic use
Drug Administration Schedule
Family
Female
Finland - epidemiology
Humans
Male
Neuropsychological Tests
Psychiatric Status Rating Scales
Risperidone - administration & dosage - therapeutic use
Schizophrenia - drug therapy - epidemiology
Schizophrenic Psychology
Severity of Illness Index
Treatment Outcome
Verbal Learning
Abstract
The safety and tolerability of short-term treatment with a low dose of risperidone was evaluated in adolescents with prodromal symptoms and a family history of schizophrenia.
Four prodromal high-risk adolescents and six first-episode patients with schizophrenia were treated with average doses of 1.0 and 1.8 mg/day of risperidone, respectively, in an 8- to 12-week open-label trial.
No significant treatment-related adverse events were noted. Severity of thought and behavior disturbance ratings declined by about 30%; performance on a test of verbal learning improved by about 100% during treatment in both prodromal and first-episode patients, changes that achieved statistical significance despite the small group sizes.
These findings are preliminary and should not be used to guide health care decisions at this time. Randomized controlled trials are needed to determine whether antipsychotic drug treatment of prodromal patients can delay or prevent onset or attenuate the clinical course of schizophrenia.
PubMed ID
12091205 View in PubMed
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Antipsychotics and mortality in first-onset schizophrenia: prospective Finnish register study with 5-year follow-up.

https://arctichealth.org/en/permalink/ahliterature107981
Source
Schizophr Res. 2013 Oct;150(1):274-80
Publication Type
Article
Date
Oct-2013
Author
Marjo Kiviniemi
Jaana Suvisaari
Heli Koivumaa-Honkanen
Unto Häkkinen
Matti Isohanni
Helinä Hakko
Author Affiliation
Social and Mental Health Services, City of Oulu, Finland; University of Oulu, Institute of Clinical Medicine, Psychiatry, Oulu, Finland. Electronic address: marjo.kiviniemi@oulu.fi.
Source
Schizophr Res. 2013 Oct;150(1):274-80
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antidepressive Agents - therapeutic use
Antipsychotic Agents - therapeutic use
Cause of Death
Female
Finland - epidemiology
Humans
Logistic Models
Longitudinal Studies
Male
Middle Aged
Registries
Retrospective Studies
Schizophrenia - drug therapy - epidemiology - mortality
Treatment Outcome
Young Adult
Abstract
Our aim was to assess the impact of the most commonly used typical and atypical antipsychotics on mortality of patients with first-onset schizophrenia.
We conducted a nationwide, register-based, five-year follow-up study of all patients presenting with first-onset of schizophrenia between 1998 and 2003. Details of reimbursed medicines were obtained from the register of Social Insurance Institution.
After adjusting for age, gender, comorbid physical diseases and patient group, the use of second generation antipsychotics (SGAs), especially clozapine, olanzapine and quetiapine, was associated with reduced risk of all-cause mortality in patients with schizophrenia, while clozapine associated with lower suicide risk. First generation antipsychotics (FGAs), specifically levomepromazine, thioridazine or clorprothixene, were associated with increased risk of all-cause mortality. The FGAs, particularly clorprothixene, were associated with decreased suicide mortality. An increased likelihood for cardiovascular deaths was found among users of levomepromazine. In antidepressants, the use of mirtazapine associated with increased risk of suicide.
Differences exist between FGAs' and SGAs' use in relation to mortality. These differences remain even when the patient's physical illness are taken into account when prescribing antipsychotic medication.
PubMed ID
23953217 View in PubMed
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Cardiovascular disease in patients with schizophrenia in Saskatchewan, Canada.

https://arctichealth.org/en/permalink/ahliterature179965
Source
J Clin Psychiatry. 2004 May;65(5):715-20
Publication Type
Article
Date
May-2004
Author
Suellen M Curkendall
Jingping Mo
Dale B Glasser
Mary Rose Stang
Judith K Jones
Author Affiliation
Healthcare Data Analysis, Vienna, VA 22180, USA. Suellen.Curkendall@cox.net
Source
J Clin Psychiatry. 2004 May;65(5):715-20
Date
May-2004
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Cardiovascular Diseases - epidemiology - mortality
Cause of Death - trends
Cohort Studies
Comorbidity
Female
Humans
Incidence
Insurance Claim Reporting - statistics & numerical data
Male
Middle Aged
Odds Ratio
Prevalence
Retrospective Studies
Risk
Saskatchewan - epidemiology
Schizophrenia - drug therapy - epidemiology - mortality
Abstract
Studies have shown that patients with schizophrenia have higher rates of cardiovascular disease and mortality compared with the general population. However, population-based data on the prevalence, incidence, and mortality of cardiovascular disease are needed.
In this retrospective cohort study, the Saskatchewan Health databases were searched for all patients diagnosed with schizophrenia (ICD-9 code 295) in 1994 or 1995. 3022 subjects were identified. For each subject, 4 age- and sex-matched comparison individuals were selected randomly among residents of the province who had no diagnosis of schizophrenia or any other mental disorders and who received no prescriptions for antipsychotic medications. Prevalence of cardiovascular morbidity during 1994 and 1995 and incidence of cardiovascular morbidity and mortality during the follow-up period of January 1996 through March 1999 were analyzed.
Concerning prevalence of morbidity in schizophrenia patients, significantly increased risk-adjusted odds ratios were as follows: arrhythmia, 1.5 (95% CI = 1.2 to 1.8); syncope, 4.0 (95% CI = 2.0 to 7.9); heart failure, 1.7 (95% CI = 1.4 to 2.2); stroke, 2.1 (95% CI = 1.6 to 2.7); transient cerebral ischemia, 2.6 (95% CI = 1.7 to 3.7); and diabetes, 2.1 (95% CI = 1.8 to 2.4). Odds of acute myocardial infarction, ischemic heart disease, and ventricular arrhythmias were not significantly different from those for the comparison group. Concerning incidence of morbidity and mortality in the patients, adjusted relative risk was significantly increased for ventricular arrhythmia, 2.3 (95% CI = 1.2 to 4.3); heart failure, 1.6 (95% CI = 1.2 to 2.0); stroke, 1.5 (95% CI = 1.2 to 2.0); diabetes, 1.8 (95% CI = 1.2 to 2.6); all-cause mortality, 2.8 (95% CI = 2.3 to 3.4); and cardiovascular mortality, 2.2 (95% CI = 1.7 to 2.8).
Persons with schizophrenia appear to be at greater risk for cardiovascular morbidity and mortality than those in the general population.
PubMed ID
15163261 View in PubMed
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Characteristics of subjects with schizophrenia spectrum disorder with and without antipsychotic medication - a 10-year follow-up of the Northern Finland 1966 Birth Cohort study.

https://arctichealth.org/en/permalink/ahliterature131251
Source
Eur Psychiatry. 2013 Jan;28(1):53-8
Publication Type
Article
Date
Jan-2013
Author
J. Moilanen
M. Haapea
J. Miettunen
E. Jääskeläinen
J. Veijola
M. Isohanni
H. Koponen
Author Affiliation
Institute of Clinical Medicine, Department of Psychiatry, University of Oulu and Oulu University Hospital, P.O. BOX 5000, 90014 Oulu, Finland. moiljani@paju.oulu.fi
Source
Eur Psychiatry. 2013 Jan;28(1):53-8
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Antipsychotic Agents - therapeutic use
Female
Finland - epidemiology
Follow-Up Studies
Hospitalization
Humans
Male
Prevalence
Recurrence
Schizophrenia - drug therapy - epidemiology
Sex Factors
Abstract
To estimate the prevalence of non-medicated subjects having schizophrenia spectrum disorder and to study how they differ from medicated subjects in terms of sociodemographic and illness-related variables. We also aim to find the predictors for successful antipsychotic withdrawal.
Data of 70 subjects with schizophrenic psychoses (mean duration of illness 10.4 years) from the Northern Finland 1966 Birth Cohort were gathered by interview at the age of 34 and from hospital records. The stability of remission was assessed by comparing hospitalization rates between non-medicated and medicated subjects over an 8.7-year additional follow-up period.
Twenty-four (34%) subjects were currently not receiving medication. They were more often males, less often on a disability pension, more often in remission, and had better clinical outcomes. Relapses during the follow-up were equally frequent between non-medicated and medicated subjects (47% vs. 56%). Not having been hospitalised during previous 5 years before the interview predicted long-term successful antipsychotic withdrawal without relapse.
Despite a lack of precise predictors, there might be subgroup of schizophrenia spectrum subjects who do not need permanent antipsychotic medication, and a fewer previous psychiatric treatments may indicate such a subgroup.
PubMed ID
21920710 View in PubMed
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Cigarette smoking in long-term schizophrenia.

https://arctichealth.org/en/permalink/ahliterature171488
Source
Eur Psychiatry. 2006 Jun;21(4):219-23
Publication Type
Article
Date
Jun-2006
Author
R K R Salokangas
T. Honkonen
E. Stengård
A-M Koivisto
J. Hietala
Author Affiliation
Department of Psychiatry, University of Turku Psychiatric Clinic, Turku University Central Hospital, 20520 Turku, Finland. Kaimo.K.R.Salokangas@tyks.fi
Source
Eur Psychiatry. 2006 Jun;21(4):219-23
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - administration & dosage
Comorbidity
Educational Status
Female
Finland - epidemiology
Humans
Interview, Psychological - methods
Male
Marital Status - statistics & numerical data
Middle Aged
Prevalence
Schizophrenia - drug therapy - epidemiology
Schizophrenic Psychology
Sex Distribution
Smoking - epidemiology - psychology
Time
Time Factors
Abstract
Cigarette smoking is a great health problem and prevalent among subjects with schizophrenia. Our aim was to investigate the prevalence and associations of cigarette smoking in patients with long-term schizophrenia.
Seven hundred and sixty schizophrenia patients were interviewed and their cigarette smoking was recorded.
Smoking was more prevalent men than in women patients. In logistic regression analysis, male gender, duration of illness (DUI) from 10 to 19 years, being divorced or separated, lower education and high daily doses of neuroleptics (DDN) associated significantly with regular smoking. Heavy smoking associated, in men, with hospital treatment.
In schizophrenia patients, smoking is associated with long DUI, high DDN and institutional care. Interventions for cessation and/or reduction of cigarette smoking should be a part of the treatment for patients with schizophrenia.
PubMed ID
16360309 View in PubMed
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Clinical epidemiologic first-episode psychosis: 1-year outcome and predictors.

https://arctichealth.org/en/permalink/ahliterature163098
Source
Acta Psychiatr Scand. 2007 Jul;116(1):54-61
Publication Type
Article
Date
Jul-2007
Author
E. Simonsen
S. Friis
U. Haahr
J O Johannessen
T K Larsen
I. Melle
S. Opjordsmoen
B R Rund
P. Vaglum
T. McGlashan
Author Affiliation
Roskilde Psychiatric University Hospital Fjorden, Roskilde, Denmark. rfes@ra.dk
Source
Acta Psychiatr Scand. 2007 Jul;116(1):54-61
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adult
Affect
Denmark - epidemiology
Female
Humans
Male
Norway - epidemiology
Prospective Studies
Psychotic Disorders - drug therapy - epidemiology
Remission Induction
Schizophrenia - drug therapy - epidemiology
Social Behavior
Abstract
To describe 1-year outcome in a large clinical epidemiologic sample of first-episode psychosis and its predictors.
A total of 301 patients with first-episode psychosis from four healthcare sectors in Norway and Denmark receiving common assessments and standardized treatment were evaluated at baseline, at 3 months, and at 1 year.
Substantial clinical and social improvements occurred within the first 3 months. At 1-year 66% were in remission, 11% in relapse, and 23% continuously psychotic. Female gender and better premorbid functioning were predictive of less severe negative symptoms. Shorter DUP was predictive for shorter time to remission, stable remission, less severe positive symptoms, and better social functioning. Female gender, better premorbid social functioning and more education also contributed to a better social functioning.
This first-episode sample, being well treated, may be typical of the early course of schizophrenia in contemporary centers.
PubMed ID
17559601 View in PubMed
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Clozapine treatment and discontinuation in Iceland: A national longitudinal study using electronic patient records.

https://arctichealth.org/en/permalink/ahliterature278094
Source
Nord J Psychiatry. 2016 Aug;70(6):450-5
Publication Type
Article
Date
Aug-2016
Author
Oddur Ingimarsson
James H MacCabe
Magnús Haraldsson
Halldóra Jónsdóttir
Engilbert Sigurdsson
Source
Nord J Psychiatry. 2016 Aug;70(6):450-5
Date
Aug-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antipsychotic Agents - therapeutic use
Clozapine - therapeutic use
Cohort Studies
Electronic Health Records - trends
Female
Follow-Up Studies
Humans
Iceland - epidemiology
Longitudinal Studies
Male
Middle Aged
Polypharmacy
Schizophrenia - drug therapy - epidemiology
Withholding Treatment - trends
Young Adult
Abstract
Clozapine is the only drug approved for treatment-resistant schizophrenia. There is evidence that clozapine is underutilized.
To evaluate the initiation and discontinuation of clozapine at Landspitali University Hospital in Iceland and the prevalence of antipsychotic polypharmacy in clozapine-treated patients.
The study is a part of an ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients on clozapine or who have been on clozapine by using a keyword search in the electronic health records and by reviewing their medical records.
Mean age at first treatment with clozapine was 37.8 years. Mean follow-up period on clozapine was 11 years. After 20 years of treatment 71.2% of patients were still on clozapine. After one year of treatment 84.4% of patients were still receiving clozapine treatment. We estimate that 11.4% of patients with schizophrenia in Iceland are taking clozapine and that 16% have been treated with clozapine at some point. Polypharmacy is common, since nearly 2/3, 65.6%, of patients taking clozapine use at least one other antipsychotic and 16.9% are also receiving depot injections.
We need to increase the awareness of psychiatrists in Iceland with regard to treatment with clozapine, since only about half of the estimated population of patients with treatment-resistant schizophrenia in Iceland have ever been treated with clozapine. Nearly two thirds of patients who are prescribed clozapine in Iceland remain on it long-term.
PubMed ID
27049594 View in PubMed
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A community-based clinic survey of antidepressant use in persons with schizophrenia.

https://arctichealth.org/en/permalink/ahliterature205217
Source
Can J Psychiatry. 1998 Jun;43(5):513-6
Publication Type
Article
Date
Jun-1998
Author
R W Lam
R. Peters
N. Sladen-Dew
S. Altman
Author Affiliation
Department of Psychiatry, University of British Columbia, Vancouver. rlam@unixg.ubc.ca
Source
Can J Psychiatry. 1998 Jun;43(5):513-6
Date
Jun-1998
Language
English
Publication Type
Article
Keywords
Antidepressive Agents - therapeutic use
Antipsychotic Agents - therapeutic use
British Columbia - epidemiology
Community Mental Health Centers - statistics & numerical data
Comorbidity
Cross-Sectional Studies
Depressive Disorder - drug therapy - epidemiology
Drug Therapy, Combination
Drug Utilization
Female
Humans
Male
Schizophrenia - drug therapy - epidemiology
Sex Factors
Abstract
To determine the rates of antidepressant and antipsychotic use in the treatment of schizophrenia.
The primary therapists at 8 community mental health centres in a metropolitan Canadian city completed a survey questionnaire for all of their active clients. Information was collected about diagnoses, medication treatments, and clinical variables.
There were 3555 clients, 1552 (43.7%) of which had a diagnosis of schizophrenia. Of clients with schizophrenia, 94% were prescribed antipsychotic medications, and 11.6% of these were also prescribed antidepressant medications. There were differences between the combination-treatment group and the antipsychotic-alone group in gender ratio, rates of concurrent diagnoses of mood disorder, level of current functioning, and total number of hospitalizations.
In this community-based sample of clients with schizophrenia, antidepressants and antipsychotics are commonly prescribed in combination, even though the rate of concurrent mood disorders diagnoses is low. Further studies should clarify the efficacy and indications for antidepressant use in this population.
PubMed ID
9653537 View in PubMed
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39 records – page 1 of 4.