Comparison of the effects of quetiapine extended-release and quetiapine immediate-release on cognitive performance, sedation and patient satisfaction in patients with schizophrenia: a randomised, double-blind, crossover study (eXtRa).

OBJECTIVES: To assess daytime cognitive performance, sedation and treatment satisfaction in patients with schizophrenia receiving quetiapine extended release (XR) versus quetiapine immediate release (IR). METHODS: Phase IV prospective, double-blind, crossover study (NCT01213836). Patients (N=66) with stable schizophrenia, treated with XR or IR before study start, were randomised (1:1) to treatment with XR followed by IR, or IR followed by XR, at the dose received before enrolment (400-750mg). After 10-16days on formulation 1, patients switched to formulation 2. Assessments from three post-dose visits (≥5days following treatment on each formulation) were analysed. Cognitive performance was measured by CogState Cognition testing. Sedation, treatment satisfaction and safety were also assessed. RESULTS: 65 patients received treatment (69.2% male; mean age 37.8years). Daytime cognitive functioning was similar for both groups; adjusted mean difference in Attentional Composite Score in XR and IR patients was 0.005 (p=0.907). Patients receiving XR were less sedated than those receiving IR, (Bond-Lader visual analogue scale score, mean [SD]: 23.5 [19.0] vs 28.6 [21.4]); estimated overall treatment difference: 5.2 (95% CI: 2.3, 8.2; p<0.0009). Patients receiving XR reported feeling less sedated than those on IR (Stanford Sleepiness Scale, mean [SD]: 2.4 [0.9] vs 2.6 [1.0]); estimated overall treatment difference: 0.28 (95% CI: 0.12, 0.43; p<0.0008). Patients reported improved overall treatment satisfaction (p=0.0417) and milder side effects (p=0.0035) with XR. Safety profile was similar in both groups. CONCLUSION: Daytime cognitive performance was similar for both groups. XR was associated with less daytime sedation and improved patient satisfaction than IR.

Quality of life and other characteristics of Viennese mental health care users.

BACKGROUND: The purposes of this study are (1) to characterise patients with different treatment experiences, (2) to evaluate differences in quality of life (QoL) among patients with different treatment experiences, (3) to evaluate changes in QoL following community resettlement, and (4) to find predictors of overall life satisfaction (OLS). METHODS: Treatment experiences are defined according to service use as follows: (a) user of in- and outpatient services (overall users), (b) user of inpatient (inpatients) or (c) outpatient facilities only (outpatients). Demographic and clinical data of 425 psychiatric patients are analysed cross-sectionally in relation to their treatment experiences. QoL of former inpatients is followed up after hospital discharge. RESULTS: Long-term 'overall users' have a significantly higher QoL than long-term 'outpatients' or 'inpatients'. QoL of former inpatients increases after discharge. Predictors of higher OLS are high income, high subjective social functioning (SFQ), good self-rated health, satisfactory QoL domains as well as being single or cohabiting, diagnosis of schizophrenia, 'outpatients', and 'overall users'. Together they explain 63% of the variance in patients' subjective OLS. CONCLUSION: QoL is independent of illness severity. Deinstitutionalisation improves QoL and OLS is mainly predicted by subjective variables.

Los predictores de "insight" con respecto a la enfermedad mental entre los pacientes psicóticos y no psicóticos

El propósito de este estudio fue 1) Crear un índice de "insight" en relación con la enfermedad mental 2) Examinar los predictores de "insight" entre una muestra regional representativa compuesta por 418 pacientes. El "insight" se definió mediante un índice basado en tres cuestiones. Además de estas cuestiones fue tenida en cuenta la estimación hecha por el entrevistador utilizando así mismo un índice. Un buen "insight" o uno "moderado" estaba asociado con una edad joven, estado civil de casado o bien de "conviviente", la existencia de confidente íntimo, el diagnóstico de un trastorno afectivo, de uno ansioso o bien de un trastorno de adaptación, así como de dependencias al alcohol o a otras drogas, baja gravedad de la enfermedad, baja edad del primer tratamiento, alta validación del tratamiento y pocas admisiones durante el periodo de estudio. Utilizando el análisis discriminante se consiguió una clasificación grupal correcta en el 44 por ciento del total de pacientes. El índice parece ser una medida rápida y aceptable que puede encontrar aplicación como método para medir los diferentes niveles de "insight" (AU)