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Guideline Adherence Impacts Mortality in Schizophrenia

Adherence to the 2009 Schizophrenia Patient Outcomes Research Team (PORT) pharmacologic guidelines appears to help reduce mortality among patients with schizophrenia, according to a study from Johns Hopkins University. The authors recommend that clinicians consider adopting outcomes-monitoring systems and innovative service delivery programs to improve adherence to the PORT guidelines. Abstract: Schizophrenia Bulletin, October 30, 2012...

Managing Low-Functioning Schizophrenics

Research suggests that one-third to one-half of patients with schizophrenia continue to experience residual symptoms or have intolerable adverse effects relating to their treatment. The effect of medications on functional outcomes has been modest, even when drug regimens are optimized. Compounding the problem are the disorganized and negative symptoms associated with schizophrenia, which are less responsive to medications than hallucinations and delusions. Today, more patients with schizophrenia are being treated in the community, but many continue to function at a low level. As such, additional interventions like cognitive therapy have been explored for schizophrenia, but these approaches have had varied success. Most cognitive therapy treatments assessed in studies have addressed delusions and hallucinations and have not focused on patients with neurocognitive impairment and poor functioning. A Novel Approach in Managing Schizophrenia In the October 3, 2011 Archives of General Psychiatry, my colleagues and I had a study published in which we assessed a novel version of cognitive therapy aimed at increasing functional outcomes and promoting recovery in low-functioning patients with schizophrenia. In addition to residual positive and negative symptoms, these individuals had trouble with information processing for memory, attention, and executive functioning. By design, our intervention shifted the emphasis from taking a symptom-oriented approach to using a person-oriented therapeutic strategy based on interests, assets, and strengths. We wanted to improve the level of functioning by enhancing productivity, independence, and the quantity and quality of social interactions. The intervention treated functional outcomes as a primary target of therapy. More patients with schizophrenia are being treated in the community, but many continue to function at a low level. Participants in the...

Antipsychotic Use in Children

In recent months, the use of antipsychotic medications in children and adolescents has been debated largely because these agents are increasingly being used in youth for non-psychotic disorders and off-label indications. In addition, there has been disagreement about the validity of certain childhood diagnoses. For example, bipolar disorder data suggest that there may be a lack of psychosocial interventions for disruptive and aggressive spectrum disorders, even if antipsychotic treatment is prescribed. Furthermore, there has been concern surrounding the adverse effects related to antipsychotic use. These effects may be more severe and have long-term health implications when they occur during early human development. “A careful risk-benefit evaluation is necessary before deciding to initiate and to maintain antipsychotic treatment in younger patients.” Even though the debate over use of antipsychotic medications in younger patients continues, there has been an increase in the available controlled efficacy database for antipsychotics for schizophrenia, bipolar mania, and autistic disorder. In turn, this has led to FDA approval of four of the most prescribed atypical antipsychotics in youth. Aripiprazole, olanzapine, quetiapine, and risperidone have FDA-approved pediatric indications for bipolar mania and for schizophrenia. Aripiprazole and risperidone are also indicated for irritability and aggression associated with autistic disorder, and we now have controlled trial data for disruptive behavior disorders (mostly with risperidone) and tic disorders. Assessing Tolerability Studies comparing antipsychotic adverse effect rates in children and adolescents with those in similar adult studies have indicated that younger patients were at higher risk for a number of antipsychotic-induced side effects, including sedation, extrapyramidal side effects, withdrawal dyskinesia, prolactin elevation, weight gain, and some metabolic abnormalities. There is a concern that...
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