Comparing effectiveness of risperidone with first-generation antipsychotic medications in patients with schizophrenia-spectrum disorders.

This naturalistic retrospective study aims to compare effectiveness of a second-generation antipsychotic medication, risperidone, with first-generation antipsychotic medications (haloperidol and trifluoperazine) in an Asian population with first-episode schizophrenia-spectrum disorders. A total of 261 patients were assessed for time to discontinuation for any reason and specific reasons of discontinuation, controlling for baseline differences between groups. Some 90% of patients discontinued their antipsychotic medications before 18 months. Median time to discontinuation for any reason in risperidone was 69 days versus first-generation antipsychotic medications of 27 days. Specifically, the risperidone group had a longer time to discontinuation for any reason than haloperidol (HR = 0.61, p = 0.005) and trifluoperazine groups (HR = 0.63, p = 0.03), as well as a longer time to discontinuation due to intolerability of side effects than haloperidol (HR = 0.50, p = 0.008) and trifluoperazine groups (HR = 0.26, p = 0.001). There were no significant differences between medications for time to discontinuation due to lack of efficacy, patient's/family's decisions or other reasons. We conclude that there is a very high rate of discontinuation of the initial antipsychotic medications for various reasons, with risperidone having an overall longer time to discontinuation compared with first-generation antipsychotic medications.

Effect of treatment on weight gain and metabolic abnormalities in patients with first-episode psychosis.

OBJECTIVE: The aim of the present prospective and naturalistic study was to examine the effects of antipsychotic medication on weight and serum levels of lipids, glucose and insulin in first-episode psychosis patients. METHOD: Fifty-six patients admitted to the Singapore Early Psychosis Intervention Programme participated in this study. They were assessed at baseline (i.e. within 72 h of starting antipsychotics), and 6 months later. Weight (kg) and height (m) were measured and body mass index (BMI) was calculated. Blood samples were taken after a 12 h overnight fast. Choice of antipsychotics was based on the treating physician's clinical decision. Total cumulative Chlorpromazine (CPZ) equivalent of antipsychotic exposure during the 6 months was calculated. Statistical analyses were carried out for comparisons between baseline and 6 months, and for the two outcome event groups of > or =7% versus <7% weight gain. Where appropriate, confounders were controlled. RESULTS AND CONCLUSION: There were significant increases in BMI, serum levels of triglyceride, low-density lipoprotein and total cholesterol from baseline to 6 months. Mean increase in weight was 6.2+/-7.0 kg (p < 0.05) and 65% of the patients had clinically significant weight gain (i.e. > or =7% increase from baseline). On logistic regression lower baseline BMI, female gender, and younger age, were associated with clinically significant weight gain.

Metabolic risk factors in drug-naive patients with first-episode psychosis.

OBJECTIVE: Metabolic risk factors, such as obesity, as well as abnormalities in glucose and lipid metabolism, have been shown to have an increased prevalence in patients with schizophrenia, especially in those treated with antipsychotic medication. However, studies looking at these abnormalities in drug-naive patients have been few in number and have yielded mixed results. The aim of our study was to look at the prevalence of some of the cardiovascular risk factors, such as obesity and lipid and glucose abnormalities, in drug-naive patients with first-episode psychosis compared to healthy controls matched for age, gender, and ethnicity. METHOD: One hundred sixty patients aged between 18 and 40 years who presented to the Early Psychosis Intervention Programme in Singapore with a diagnosis of first-episode psychosis according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition were assessed for their body mass index (BMI) and plasma levels of fasting glucose and lipids. The results of this assessment were compared to similar data from 200 controls matched for age, gender, and ethnicity, collected as part of an annual workplace health screening. The study was conducted from June 2002 to March 2005. RESULTS: There were significant differences in the mean baseline weight, BMI, and plasma levels of total and LDL cholesterol; all of these values were significantly higher in the controls compared to patients (p < .005 for all). Controls were significantly more likely to have high BMI (>or= 23 kg/m(2)) and high LDL cholesterol level (> 3.4 mmol/L) as compared to patients (p < .005 and p = .01, respectively). However, patients compared to controls were significantly more likely to have diabetes (p = .007). CONCLUSION: The link between diabetes and psychotic illness previously reported in relatives of patients with schizophrenia and in medication-naive patients implies a possible genetic link between schizophrenia and abnormal glucose metabolism. However, the finding of low prevalence of obesity and dyslipidemia at the onset of illness suggests that the increased frequency of these abnormalities in patients is an effect of their antipsychotic medication.

Chemical and rheological aspects of gel formation in the California Mastitis Test.

The rheological properties of the CMT gel were analysed. Data are presented to demonstrate that the gel is a non-homogenous, visco-elastic, non-Newtonian fluid with rheopectic, and rheodestructive behaviour. The fundamental chemistry of the CMT is reviewed and a modified theory of gel formation is presented. The implications of the rheological properties and modified theory of gel formation for an automatic sensor are discussed.