[Source-monitoring deficits in schizophrenia: review and pharmacotherapeutic implications]. / A forrásmonitorozás zavarai szkizofréniában: áttekintés és farmakoterápiás következtetések.

The disturbance of source-monitoring is one of the various impairments in cognitive functioning observed in schizophrenic patients. The process of source-monitoring allows individuals to distinguish self generated thoughts and behaviours from those generated by others. The aim of the present study is to review the general psychological definition of source memory and source-monitoring and its neurological basis as well as the models for explanation of source-monitoring deficits. The relationship between source-monitoring-deficits and psychopathological symptoms as well as the effect of antipsychotic treatment on source-monitoring disturbances are introduced. There is evidence suggesting, that a selective source-monitoring deficit is in the occurrence of auditory hallucinations. The disturbance of prospective memory may influence unfavorably the compliance. Administration of antipsychotics in general can improve source-monitoring deficits. The neuropsychiatric perspective provides a more accurate and comprehensive understanding of schizophrenia.

[Administration of once-daily extended release quetiapine in schizophrenic disorders]. / A quetiapin napi egyszeri adagolású lassú felszívódású (XR) formulájának alkalmazása szkizofrén kórképekben.

This article reviews the published clinical data on schizophrenic patients managed with the new formulation of quetiapine, the once-daily extended release quetiapine fumarate (quetiapine XR). Quetiapine XR has been developed to reduce the frequency of quetiapine dosing by introducing once-daily administration and to simplify the treatment initiation schedule. Quetiapine XR (400 to 800 mg/day) was effective versus placebo across a broad range of symptom domains in acute schizophrenia and was as well tolerated as the immediate release (IR) formulation. Rapid dose escalation of quetiapine XR (300 mg on day 1,600 mg on day 2, and 800 mg on day 3) was also well tolerated, with a therapeutically effective dose reached by day 2. Clinically stable patients with schizophrenia receiving quetiapine IR (400-800 mg/day) can be switched to an equivalent once-daily dose of quetiapine XR (400-800 mg/day once-daily) without clinical deterioration or compromise in tolerability. Evidence from a clinical trial has shown that patients with schizophrenia who had a history of unsatisfactory treatment (tolerability or efficacy) on typical or atypical antipsychotic experienced improved efficacy and clinical benefit when switched to quetiapine XR. Once-daily quetiapine XR (400-800 mg/nap) was effective compared with placebo in preventing relapse in patients with clinically stable schizophrenia, and was well tolerated during long-term use. Patients could be switched from their ongoing antipsychotic to quetiapine XR within 4 days without compromising efficacy, enabling a dose of 600 mg/day and 800 mg/day to be reached by Day 2 and Day 3 respectively. This new, once-daily formulation of quetiapine offers psychiatrists and patients valuable new treatment options for the short and long-term treatment of schizophrenia.

[New formulations of olanzapine in the treatment of acute agitation]. / Az olanzapin új gyógyszerformái az akut agitáció kezelésében.

UNLABELLED: Agitation is common in patients with acute schizophrenia or bipolar mania, and when severe can result in aggressive or violent behaviour. Pharmacotherapy for acute psychotic agitation includes the use of antipsychotic and benzodiazepine drugs, either alone or in combination. Although oral treatment is preferred, options in the pharmacotherapy of acute agitation include the parenteral administration of antipsychotics in order to facilitate onset of drug action and quickly alleviate symptoms. Until recently only conventional antipsychotic and benzodiazepine drugs were available as intramuscular injections. Olanzapine has been one of the first atypical antipsychotics available for intramuscular administration. Four randomized placebo and comparator controlled , double-blind clinical trials have demonstrated the efficacy of olanzapine in reducing acute agitation in patients with schizophrenia, bipolar mania and Alzheimer and vascular dementia. Evidence from these clinical trials has shown that IM olanzapine associated with faster onset of action and more favorable profile of adverse events, than monotherapy with IM haloperidol. Current clinical experience and one naturalistic study with intramuscular olanzapine suggest that it is efficacious and can be safely used in "real world" patients with severe agitation. Intramuscular olanzapine have shown ease of transition to same agent oral therapy once the acute agitation has diminished. The orally disintegrating tablet formulation of olanzapine was effective rapidly reducing psychopathology, while improving medication compliance, attitudes and behaviours. This new formulation of olanzapine may offer an alternative strategy in the treatment of acutely ill, noncompliant schizophrenic patients. Evidence suggests that the new formulations of olanzapine should be among the first-line choices in the treatment of agitation in acute psychosis. KEYWORDS: olanzapine, intramuscular, orally disintegrating tablet, agitation, psychosis.

[Switching patients with schizophrenia to ziprasidone from conventional or other atypical antipsychotics]. / Váltás ziprasidonra hagyományos vagy más atípusos antipszichotikumokról szkizofréniában szenvedö betegekben.

OBJECTIVES: The aim of the study was to assess the efficacy, tolerability and safety of ziprasidone in patients with schizophrenia who were already treated with conventional or other atypical antipsychotics that had to be switched due the lack of efficacy or bad tolerance. METHODS: The study was a 12-week, open label, multicenter, non comparative trial on oral ziprasidone. 106 patients with DSM-IV schizophrenia were switched to ziprasidone from their previous antipsychotic without a washout phase. The study required fixed dosing with ziprasidone. For the first week the patient received 80 mg of study drug daily, followed for 3 weeks 120 mg/day. Subsequently for 8 weeks either 80 mg, or 120 mg, or 160 mg total daily dose could be given at the discretion of the investigator. Baseline and outcome assessment included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Severity of Illness Subscale (CGI-S) and Global Improvement Subscale (CGI-I), Calgary Depression Scale (CAD), Hamilton Depression Scale (HAMD), Drug Attitude Inventory (DAI), Simpson Angus Extrapyramidal Symptoms Rating Scale (SAS) and Barnes Akathisia Rating Scale (BARS). Changes in overall body weight were also evaluated. RESULTS: After 12 weeks on ziprasidone therapy, significant improvements were observed on all major symptoms measures and subscales. 34 (51,5%) patients (ITT) were rated much or very much improved on CGI-I at week 12. The mean SAS score significantly reduced during the ziprasidone treatment period (p<0.001). In the DAI ziprasidone treatment was also favorable rated. During treatment with ziprasidone for 12 weeks the body weight of the patients was significantly reduced (mean: 1,2 kg, SD=3,79, p=0.002). 58 adverse events occurred in 41 subjects (38.7%), of whom 7 patients (6.6%) encountered 9 severe adverse events. The adverse events were mainly mild and moderate. 15 patients (14.2%) were discontinued from the study due to adverse events. The reason for discontinuation in 4 cases was mainly insufficient clinical response. CONCLUSION: Switching patients from their previous antipsychotic to ziprasidone without a washout phase was generally well tolerated and was associated with symptoms improvements 12 weeks later. At least 50% of patients who needed to be switched because of unsatisfactory efficacy or poor tolerance were significantly improved on ziprasidone therapy. The favorable safety profile of ziprasidone treatment was consistent with that seen in other clinical trials. KEYWORDS: switching, ziprasidone, schizophrenia.

[Pharmacoeconomic review of the use of injectable long-acting risperidone]. / A tartós hatású risperidon injekció alkalmazásának farmakoökonómiai vonatkozásai.

Schizophrenia is a severe and chronic illness as well as one of the most expensive illnesses to treat. Relapse and rehospitalisation contributes significantly to the economic burden of schizophrenia. Partial compliance with antipsychotic medication was associated with an increased risk of inpatient hospitalization. Health care resource use is significantly reduced in patients with stable schizophrenia or schizoaffective disorder receiving long-acting, injectable risperidone. It is highly likely that these reductions will decrease healthcare costs in patients receiving long-acting risperidone. In this article cost-effectiveness models of long-acting risperidone developed for different countries are discussed. Long-acting risperidone produced additional clinical benefit and cost savings compared with other treatment strategies, despite significant variations in cost-effectiveness. One factor remained valid for each country: improved adherence arising through the use of long-acting risperidone provides a cost-effective strategy for treating patients with schizophrenia. On the basis of the cost-effectiveness evaluations in different countries long-acting risperidone seems to offer a cost saving treatment option for patient with schizophrenia under Hungarian circumstances. Further assessment of these models in a pragmatic study and actual monitoring of health care resource utilization should confirm the above assumption.

Olanzapine versus clozapine in treatment-resistant or treatment-intolerant schizophrenia.

Clozapine has been the gold standard for treatment of patients with refractory schizophrenia but is associated with serious safety liabilities. This has prompted the search for therapeutic alternatives for treatment-resistant schizophrenia. The objective of this study was to compare the efficacy and safety of olanzapine versus clozapine in schizophrenic patients who failed to respond adequately to antipsychotic medication or who experienced intolerable adverse effects associated with the medication. This 18-week, randomized, double-blind, parallel study compared treatment with either olanzapine (5-25 mg/day, n=75) or clozapine (100-500 mg/day, n=72) in patients with schizophrenia who were nonresponsive to, or intolerant of, standard acceptable antipsychotic therapy. At the 18-week endpoint, no statistically significant differences were found between olanzapine and clozapine in any efficacy measure used: Positive and Negative Syndrome Scale (PANSS) total, positive, negative, or general psychopathology or Clinical Global Impression severity (CGI-S). Response rates based on the criteria of Kane et al. [Arch. Gen. Psychiatry 45 (1988) 789] were also not significantly different between olanzapine-treated (57.9%) and clozapine-treated patients (60.8%). There were no significant differences in measurements of extrapyramidal symptoms or electrocardiography, and no clinically and statistically significant changes were seen in vital signs or laboratory measures in either group. Both treatments were well tolerated. Olanzapine demonstrated similar efficacy to clozapine in patients who had failed previous treatment because of lack of efficacy (treatment resistance) or intolerable side effects (treatment intolerance). Olanzapine therefore presents a safe alternative in the treatment of refractory schizophrenia.

[The use of RBANS test (Repeatable Battery for the Assessment of Neuropsychological Status) in neurocognitive testing of patients suffering from schizophrenia and dementia]. / Az RBANS teszt alkalmazása schizophren es dementiában szenvedó betegek neurokognitív vizsgálatában.

INTRODUCTION: The purpose of our study was to find out whether the Hungarian adaptation of the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status), a brief neurocognitive screening test, is appropriate for the differentiation of healthy and non-healthy subject groups, or for the detection of differences between the cognitive performance of patient groups. PATIENTS AND METHODS: The test battery was administrated to 38 healthy subjects, 69 schizophrenic patients, and 18 patients suffering from dementia (10 probable Alzheimer-type and eight vascular dementia). RESULTS: There was a significant decrease of performance in all patient groups compared to the healthy group. In the schizophrenic group, the test indicated a deterioration of functioning in all cognitive areas. The patient group with Alzheimer-type dementia performed only slightly better than the schizophrenic group, because the fall of performance was not significant only one of the cognitive areas (in the visuo-spatial tasks) when compared to the healthy group. There was no difference between the performance of patients with vascular dementia and that of healthy subjects in direct memory, verbal and visuo-spatial tasks. The test results indicated an even deterioration of cognitive areas in patients with Alzheimer-type dementia. As for the vascular dementia group, the most vulnerable area proved to be that of attention, while their verbal functions were relatively spared. The deterioration in other cognitive functions shown by schizophrenic subjects was more moderate, but still significant. A comparison of the RBANS scores of the schizophrenic patients in our study and the result of an American study was also carried out. The global indeces showed no difference; only the pattern of the sub-scales was a little different. CONCLUSION: The Hungarian version of the RBANS seems approprite for the differentiation of healthy and deteriorated cognitive performance in a Hungarian patient population.

Patient satisfaction after switching from conventional to new atypical antipsychotics in schizophrenia.

OBJECT: To study the satisfaction and subjective experiences of patients with schizophrenia after switching from a conventional to a new atypical antipsychotic, and the relationship of patient satisfaction to clinical improvement METHOD: Seventy-four chronic schizophrenia (DSM-IV) patients in a naturalistic setting whose response to a conventional antipsychotic was unsatisfactory (clinical improvement or intolerance of side-effects) switched to olanzapine or quetiapine or risperidone. After 3 months, patients completed a seven-item Patient Satisfaction Questionnaire, and a psychiatrist assessed the clinical global improvement. RESULTS: Forty-five (61%) of the patients were either very or extremely satisfied with the new medication and 47 (63.5%) rated it very or extremely helpful; 35 (47%) of the patients reported no side-effects. Fiftyone (69%) indicated that they preferred the new medication to previous therapy: better tolerability was given as the reason by 40 (54%) patients. Fifty-eight (78%) patients perceived a general improvement in their quality of life. Slightly fewer patients reported improvement in their symptoms and their daily living activities. Over 75% of patients expressed readiness to continue the new medication. Significant association between clinical response and patient satisfaction was demonstrated by only a small subgroup of patients. CONCLUSIONS: In the majority of schizophrenia patients, administration of new atypical antipsychotics seemed to result in higher levels of patient satisfaction than did conventional drugs. This had a favourable effect on the patients' attitude to the new medication, which may improve compliance. More patients perceived benefits related to quality of life than to efficacy. Clinical improvement was an important, but not the sole, determinant of patient satisfaction with medication.