Advertisement

CNS Drugs

, Volume 4, Issue 1, pp 8–16 | Cite as

The Aims of Antipsychotic Medication

What Are They and Are They Being Achieved?
  • A. George Awad
  • Lakshmi N. P. Voruganti
  • Ronald J. Heslegrave
Leading Article

Abstract

Summary

The aims of therapy with antipsychotic medications include effecti ve relief of symptoms without the induction of adverse effects, improved quality of life and cost effectiveness, and positive long term outcomes. However, currently available anti psychotics do not meet all of these requirements due to a number of well recognised limitations, such as a marked variability of response, induction of a wide range of adverse effects and a lack of subjective tolerability.

A lack of response to antipsychotic medications occurs in up to 30% of patients and poses a particular challenge to clinicians. The reintroduction of clozapine for the treatment of patients with refractory schizophrenia has proven useful in a good number of patients, albeit with some risk of serious agranulocytosis and at a relatively high cost.

Despite the extensive use of anti psychotics over the last 4 decades, little attention has been paid to the systematic evaluation of quality of life in patients with schizophrenia who receive medications, and in clinical trials of new agents. Similarly, there is a dearth of studies that have examined the cost effectiveness and cost utility of anti psychotics in terms of quality of life.

In general, the aim of anti psychotics of alleviating psychotic symptoms without negatively affecting the functional status of patients has not been adequately, nor consistently, achieved with currently available agents. However, with the recent acceleration in the development of new antipsychotics, it is hoped that new drugs will soon be available which will prove to be more effective in treating more symptoms of schizophrenia and will be associated with fewer, or ideally no, adverse effects.

Keywords

Schizophrenia Adis International Limited Clozapine Risperidone Antipsychotic Medication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Davies LM, Drummond ME. The economic burden of schizophrenia. Psychiatr Bull 1990; 14: 522–5CrossRefGoogle Scholar
  2. 2.
    Gunderson JG, Mosher LR. The cost of schizophrenia. Am J Psychiatry 1975; 132: 901–6PubMedGoogle Scholar
  3. 3.
    Wyatt RJ. Cost and savings in schizophrenia. Presentation to the Third Workshop on Cost and Assessment in Psychiatry; 1994 Oct 28-30; Venice,ItalyGoogle Scholar
  4. 4.
    Cole JO, Goldberg SC, Klerman GL. Phenothiazine treatment in acute schizophrenia. Arch Gen Psychiatry 1964; 10: 246–61CrossRefGoogle Scholar
  5. 5.
    Goldberg SC, Klerman GL, Cole JO. Changes in schizophrenic psychopathology and ward behaviour as a function of phenothiazine treatment. Br J Psychiatry 1965 111; 120–3PubMedCrossRefGoogle Scholar
  6. 6.
    Cole JO, Klerman GL, Davies JM. Drugs in the treatment of psychosis in controlled studies. In: Solomon P, editor. Psychiatric drugs. New York: Grune and Stratton, 1966: 153–80Google Scholar
  7. 7.
    Davis JM, Schaffer CB, Killman GA, et al. Important issues in the treatment of schizophrenia. Schizophr Bull 1980; 6: 70–87PubMedGoogle Scholar
  8. 8.
    Davis JM. Overview: maintenance therapy in psychiatry: I. Schizophrenia. Am J Psychiatry 1975; 132: 1237–45PubMedGoogle Scholar
  9. 9.
    Leff JP, Wing JK. Trial maintenance therapy in schizophrenia. BMJ 1971; 2: 599–603CrossRefGoogle Scholar
  10. 10.
    Prien RF, Levine J, Switalsky RN. Discontinuation of chemotherapy for chronic schizophrenics. Hosp Community Psychiatry 1977; 22: 4–9Google Scholar
  11. 11.
    Awad AG. Drug therapy in schizophrenia — variability of outcome and prediction of response. Can J Psychiatry 1989; 34: 711–20PubMedGoogle Scholar
  12. 12.
    Judd LL, Goldstein MJ, Rodnick EH, et al. Phenothiazine effects in good premorbid schizophrenics divided into paranoid- non paranoid status. Arch Gen Psychiatry 1973; 29: 207–11PubMedCrossRefGoogle Scholar
  13. 13.
    Rappaport M, Hopkins KH, Hall K, et al. Are there schizophrenics for whom drugs may be unnecessary or contraindicated? Int Pharmacopsychiatry 1987; 13: 100–11Google Scholar
  14. 14.
    May PRA, Goldberg Sc. Prediction of schizophrenic patients’ response to pharmacotherapy. In: Lipton MA, Di Mascio A, Killam KF, editors. Psychopharmacology: a generation of progress. New York: Raven Press, 1978: 1135–9Google Scholar
  15. 15.
    Lydiard BR, Laird LK. Prediction of response to anti psychotics. J Clin Psychopharmacol 1988; 8: 3–13PubMedGoogle Scholar
  16. 16.
    Stern RG, Kahn RS, Davidson M. Predictors of response to neuroleptic treatment in schizophrenia. Psychiatr Clin North Am 1993; 16: 313–38PubMedGoogle Scholar
  17. 17.
    Awad AG. Prediction research of neuroleptic treatment outcome in schizophrenia — state of the art: 1978-1993. In: Gaebel W, Awad AG, editors. Prediction of neuroleptic treatment outcome in schizophrenia - concepts and methods. Vienna: Springer-Verlag, 1994: 1–4CrossRefGoogle Scholar
  18. 18.
    Kane J, Honigfeld G, Singer J, et al. Clozapine for the treatment-resistant schizophrenics. Arch Gen Psychiatry 1988; 45: 789–96PubMedCrossRefGoogle Scholar
  19. 19.
    Lieberman JA, Kane JM, Johns CA. Clozapine: guidelines for clinical management. J Clin Psychiatry 1989; 50: 329–38PubMedGoogle Scholar
  20. 20.
    Awad AG. There are real risks and benefits with clozapine in schizophrenia. Med North Am 1992; 4: 234–8Google Scholar
  21. 21.
    Awad AG. Subjective response to neuroleptics in schizophrenia. Schizophrenia Bull 1993; 19: 609–18Google Scholar
  22. 22.
    Van Putten T, May PRA, Marder SR, et al. Subjective response to antipsychotic drugs. Arch Gen Psychiatry 1978; 38: 187–90CrossRefGoogle Scholar
  23. 23.
    Hogan TP, Awad AG, Eastwood MR. Self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative ability. Psychol Med 1983; 13: 177–83PubMedCrossRefGoogle Scholar
  24. 24.
    Hogan TP, Awad AG. Subjective response to neuroleptics and outcome in schizophrenia: a re-examination comparing two measures. Psychol Med 1992; 22: 347–52PubMedCrossRefGoogle Scholar
  25. 25.
    Awad AG, Hogan TP. Subjective response to neuroleptics and the quality of life: implications for treatment outcome. Acta Psychiatr Scand 1994; 89 Suppl. 380: 27–32CrossRefGoogle Scholar
  26. 26.
    Awad AG. Quality of life of schizophrenic patients on medications and implications for new drug trials. Hosp Community Psychiatry 1992; 3: 261–5Google Scholar
  27. 27.
    Awad AG. Quality of life in medicated schizophrenics: therapeutic and research implications. In: Shriqui C, Nasrallah H, editors. Contemporary issues in the treatment of schizophrenia. Washington: American Psychiatric Association Press, 1995: 883–46Google Scholar
  28. 28.
    Voruganti LNP, Heslegrave R, Awad AG. Schizophrenia, antipsychotic therapy and quality of life — validation of a conceptual model. Presentation to 33rd Annual Meeting of the American College of Neuropsychopharmacology; 1994 Dec 12-16Google Scholar
  29. 29.
    Schipper H, Clinch J, Powell V. Definition and conceptual issues. In: Spilker B, editor. Quality of life assessments in clinical trials. New York: Raven Press, 1990: 11–24Google Scholar
  30. 30.
    Davidhizar RE. Can clients with schizophrenia describe feelings and beliefs about taking medications. J Adv Nursing 1985; 10: 469–73CrossRefGoogle Scholar
  31. 31.
    Awad AG. Quality of life on neuroleptics - implications for health economics and drug trials in schizophrenia. Presentation to the Third Workshop on Cost and Assessment in Psychiatry; 1994 Oct 28-30; VeniceGoogle Scholar
  32. 32.
    Skantze K, Maim U, Decker SJ, et al. Comparison of quality of life with standard of living in schizophrenia out-patients. Br J Psychiatry 1992; 161: 797–801PubMedCrossRefGoogle Scholar
  33. 33.
    Fitton A, Benfield P. Clozapine: an appraisal of its pharmacoeconomic benefits in the treatment of schizophrenia. PharmacoEconomics 1993; 4: 131–56PubMedCrossRefGoogle Scholar
  34. 34.
    Kane JM, Lieberman JA. Maintenance pharmacotherapy in schizophrenia. In: Meltzer H, editor. Psychopharmacology: the third generation of progress. New York: Raven Press, 1987: 1103–9Google Scholar
  35. 35.
    Glick ID. Neuroleptic psychosocial interactions and prediction of outcome. In: Gaebel W, Awad AG, editors. Prediction of neuroleptic treatment outcome in schizophrenia. Vienna: Springer-Verlag, 1994: 65–70CrossRefGoogle Scholar
  36. 36.
    Glick ID, Spencer JH, Clarkin JF, et al. A randomized clinical trial of impatient family intervention: IV. Follow-up results for subjects with schizophrenia. Schizophr Res 1990; 3: 187–200PubMedCrossRefGoogle Scholar
  37. 37.
    Schooler NR, Keith SJ, Severe JB, et al. Acute treatment response and short-term outcome in schizophrenia in first results of NIMH treatment strategies in schizophrenia study. Psychopharmacol Bull 1989; 25: 331–5PubMedGoogle Scholar
  38. 38.
    Herz MI.Intermittent medication and schizophrenia. In: Kane JM, editor. Drug maintenance strategies in schizophrenia. Washington: American Psychiatric Association, 1984: 58–68Google Scholar
  39. 39.
    Carpenter WT, Heinricks OW, Hanlan TE. A comparative trial of pharmacologic strategies in schizophrenia. Am J Psychiatry 1987; 144: 1466–70PubMedGoogle Scholar
  40. 40.
    Gaebal W, Frick U, Kiipcke W, et al. Early neuroleptic intervention in schizophrenia: are prodromal symptoms valid predictors of relapse? Br J Psychiatry 1993; 163 Suppl. 21: 8–21Google Scholar
  41. 41.
    Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep 1962; 10: 799–812CrossRefGoogle Scholar
  42. 42.
    Wing JK, Birley JLT, Cooper JE, et al. Reliability of a procedure for measuring and classifying present psychiatric state. Br J Psychiatry 1967; 113: 499–575PubMedCrossRefGoogle Scholar
  43. 43.
    Andreason NC, Olsen SA. Negative versus positive schizophrenia, definition and validation. Arch Gen Psychiatry 1982; 39: 789–94CrossRefGoogle Scholar
  44. 44.
    Kay SR, Opler LA, Fiszbein A. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76PubMedGoogle Scholar
  45. 45.
    Awad AG. Methodological and design issues in clinical trials of new neuroleptics — an overview. Br J Psychiatry 1993; 163 Suppl. 22: 51–7Google Scholar
  46. 46.
    Snaith RP. Measurement in psychiatry. Br J Psychiatry 1991; 159: 78–82PubMedCrossRefGoogle Scholar
  47. 47.
    Gerlach J. New anti psychotics: classification, efficacy and adverse effects. Schizophr Bull 1991; 17: 298–309Google Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • A. George Awad
    • 1
  • Lakshmi N. P. Voruganti
    • 1
  • Ronald J. Heslegrave
    • 1
  1. 1.Department of PsychiatryUniversity of Toronto, The Wellesley HospitalTorontoCanada

Personalised recommendations