Pharmacological treatment for schizoaffective disorder : A comparison with schizophrenia and bipolar disorder.

BACKGROUND: Bipolar disorder and schizophrenia are severe mental illnesses, each with a prevalence of approximately 1-2% in the general population. There is considerable controversy about differentiating schizophrenia from schizoaffective or bipolar disorder owing to many similarities in psychopathology, progression, and biological factors. The aim of this study was to identify similarities and differences in the pharmacological treatment of these disorders by comparing the prescription patterns. METHOD: In this retrospective, explorative study we analyzed the prescribed medication of 300 patients with bipolar, schizophrenic, or schizoaffective disorders from data obtained from ten German adult psychiatric clinics of the LWL ("Landschaftsverband Westfalen-Lippe") psychiatric network. RESULTS: Only 21.8% of patients analyzed were consistently compliant in taking their medication before hospitalization. Polypharmacy was applied in 75.6% of cases, whereby 2.27 psychopharmacological agents were prescribed at discharge. Briefly, we observed greater similarity between prescription patterns associated with bipolar and schizoaffective disorders than with schizophrenia prescription patterns. CONCLUSION: Polypharmacy tends to be more the rule than the exception, especially when patients present with affective psychotic features. Bipolar and schizoaffective disorders cannot be differentiated according to their prescription patterns.

Amisulpride augmentation in patients with schizophrenia partially responsive or unresponsive to clozapine. A randomized, double-blind, placebo-controlled trial.

INTRODUCTION: Only limited data are available on the effectiveness of augmented antipsychotics to clozapine therapy in chronic schizophrenia. We conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the efficacy and safety of augmentation with the atypical neuroleptic amisulpride to clozapine in a small sample group of patients. METHODS: 16 patients with the DSM-IV diagnosis of chronic schizophrenia and partially responsive to clozapine participated in this pilot study. Patients on a steady dose of clozapine randomly received either clozapine and amisulpride 400 mg/day (n=7) or clozapine and amisulpride 600 mg/day (n=6) or clozapine and placebo for 6 weeks (n=3). Efficacy measures were BPRS, CGI, GAF and MADRS score. Side effects and prolactin levels were obtained. Primary outcome measure were BPRS score changes. RESULTS: The beneficial effect of augmented amisulpride at a daily dose of 600 mg was observed in the mean scores of secondary outcome measures, as assessed by GAF, CGI and MADRS. Measures of primary objectives failed to improve significantly. No reduction in BPRS total score was achieved due to lack of power of the study, whereas the BPRS subscore "activity" had a tendency to improve. Amisulpride was more beneficial in a higher than a lower dose. No severe side-effects occurred, but tremor, bradykinesia, akathisia and elevated prolactin levels were recorded. DISCUSSION: Augmented amisulpride improved the global outcome of patients suffering from chronic schizophrenia in this pilot study and tended to be a helpful treatment option in cases of partial or non-responsiveness to clozapine. Limitations emerge from the small sample size and lack of power. Further investigation requires a larger number of patients to be included.

[Ethnic background related pharmacological differences]. / Wie schnell metabolisiert Ihr Patient?

The cytochrome P-450 enzyme plays a key role in the metabolization of many medicinal products. Certain ethnic groups particularly often show gene polymorphisms that lead to more rapid or slower metabolization of the active substance depending on how the enzyme activity is affected. This should be taken into consideration when prescribing the dosage of medicines to avoid increased side effects or therapeutic failure.

[Neuroleptic-induced supersensitivity]. / Neuroleptisch induzierte Supersensitivität.

Psychopharmacological agents may cause changes in receptor sensitivity. Long-term treatment with high doses of neuroleptics has been shown to lead to supersensitivity of postsynaptic dopamine and noradrenaline receptors. Receptor supersensitivity is seen more frequently with neuroleptics known to have a high receptor affinity. The mechanism by which psychoses of the supersensitivity type work is presented and is illustrated by two case reports. Possible pathophysiological mechanisms for the emergence of these psychoses and implications for the treatment of patients suffering from them are discussed.

[Quality assurance in the psychiatric hospital--joint medical-pharmaceutical visits]. / Qualitätssicherung im psychiatrischen Krankenhaus--gemeinsame ärztlich-pharmazeutische Visiten.

The authors report on two years of experience collected during jointly performed medico-pharmaceutical visits in a psychiatric hospital. From the viewpoint of quality assurance and quality control such a procedure has now gained topical importance. Attention is drawn to problematic drug regimens and interactions between drugs.

Antitumor activity of new nitrosoureas on Yoshida sarcoma ascites cells implanted into the colon wall of rats.

The chemotherapeutic activity of 12 newly synthesized nitrosoureas was compared in tests using Yoshida sarcoma ascites cells implanted into the wall of the descending colon in Sprague-Dawley rats. Cyclophosphamide and the nitrosoureas BCNU, MeCCNU, and chlorozotocin served as positive controls. Among the nitrosoureas tested, 1-(2-hydroxyethyl)-3-(2-chloroethyl)-3-nitrosourea (hydroxyethyl-CNU), chlorozotocin, 1-(2-chloroethyl)-1-nitroso-3-(4-morpholino) urea, 1-(2-chloroethyl)-1-nitroso-3-(1-piperidino) urea, 4-[1-(2-chloroethyl)-1-nitroso-3-[4-(2,6-dimethylmorpholino)] urea, and 1-(2-chloroethyl)-1-nitroso-3-(3,4-methylenedioxybenzyl) urea were found to be the most active compounds in this tumor model. Based on the present results, morpholino-CNU is considered the most promising compound among these newly synthesized BCNU analogues.

Antitumor activity of 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) and 1-(2-chloroethyl)-3-(4-methyl-cyclohexyl)-1-nitrosourea (MeCCNU) on Yoshida sarcoma ascites cells implanted into the colon wall of rats.

Three thousand Yoshida sarcoma cells were inoculated into the wall of the descending colon of each of 120 male Sprague-Dawley rats. On day 8 after the tumor implantation, the animals were at random divided into four groups of 30 rats each. The effect of cyclophosphamide (70 mg/kg), BCNU (25 mg/kg), and methyl-CCNU (45 mg/kg) after single i.p. application was investigated. The Yoshida sarcoma transplanted into the colon is sensitive to all three chemotherapeutic drugs. At the doses given cyclophosphamide showed the best results. The two nitrosoureas had a comparable antitumor activity but methyl-CCNU showed a more distinct toxic effect. The introduction of this model for testing new cytostatics in animal experiments is discussed.