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Journal Article 2007; 28(Suppl 1): 27-33 PubMed PMID: 17262009 Citation  Keywords:  Antipsychotic Agents:therapeutic use, Humans, Patient Compliance, Psychiatry, Psychotic Disorders:drug therapy, Treatment Outcome,.   

: Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid....

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Journal Article 2007; 28(Suppl 1): 49-70 PubMed PMID: 17262007 Citation  Keywords:  Antipsychotic Agents:therapeutic use, Double-Blind Method, Humans, Placebos, Randomized Controlled Trials as Topic, Recurrence, Research Design, Schizophrenia:drug therapy, Treatment Outcome,.   

: Fourteen long-term (duration at least 26 months) double-blind, randomized studies comparing second-generation antipsychotics (SGAs) with placebo, conventional antipsychotics, or two or more SGAs, published after 2002 have been reviewed and are summarized in this chapter. Methodological problems and factors influencing results such as patient populations involved, outcome criteria, and dosages of evaluated drugs are discussed....

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Journal Article 2007; 28(Suppl 1): 71-93 PubMed PMID: 17262006 Citation  Keywords:  Anticonvulsants:therapeutic use, Antidepressive Agents:therapeutic use, Antimanic Agents:therapeutic use, Antipsychotic Agents:therapeutic use, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Drug Therapy, Combination, Humans, Lithium Carbonate:t.   

: Several lines of clinical, genetic, and pharmacological evidence point to an association between bipolar and psychotic disorders. The goals of maintenance and prophylactic treatment of bipolar disorder include the prevention of new episodes and the improvement of social, family, and occupational functioning. This goal can be mainly achieved by using long-term adequate pharmacological treatment that is tolerable to patients. Among mood-stabilizers, the main drugs used for such treatment, the role of atypical antipsychotics has greatly increased in recent years. Lithium still remains the drug that has produced the most convincing evidence of prophylactic action and has undergone the longest periods of observation. There has also been good confirmation for the maintenance efficacy of such anticonvulsant drugs as carbamazepine, valproate, and lamotrigine, the last having the strongest properties for prophylaxis of depressive episodes. The case for the usefulness of second-generation antipsychotic drugs in the long-term treatment of bipolar disorder has been rapidly accumulating. Based on controlled trials, the best evidence for maintenance efficacy exists for olanzapine. The vast majority of patients with bipolar illness experience inadequate response to monotherapy with mood-stabilizing drugs during long-term treatment. Some issues connected with polypharmacy targeting optimal maintenance results are discussed. In addition, the long-term management and the role of antidepressants in treatment of non-bipolar I illness is also briefly described....

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Journal Article 2007; 28(Suppl 1): 95-116 PubMed PMID: 17262005 Citation  Keywords:  Antipsychotic Agents:metabolism, Humans, Patient Compliance, Risk Factors, Schizophrenia:drug therapy, Schizophrenic Psychology, Treatment Refusal,.   

: Adherence to treatment is a general indicator of quality and success of communication between the physician and the patient. It means the extent to which patient behaviour, in terms of taking medications, following diets, or executing life-style changes, coincides with medical or health advice. Nonadherence to antipsychotic therapy in patients with schizophrenia is far more widespread than clinicians assume. Lower nonadherence in therapy based on antipsychotics of the second generation compared with conventional medications has already been indicated by early reports. The consequences of nonadherence include exacerbation of symptoms, an increased relapse rate, psychiatric hospitalization hospitalisation, and less favourable patient prognosis. There are several factors that cause treatment nonadherence in schizophrenia: causes derived from the schizophrenic disorder itself, patient characteristics, causes associated associated with the health-care system, and the antipsychotic treatment itself....

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Journal Article 2007; 28(Suppl 1): 117-133 PubMed PMID: 17262004 Citation  Keywords:  Antipsychotic Agents:adverse effects, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Humans, Long-Term Care, Quality of Life, Schizophrenia:drug therapy, Treatment Outcome,.   

: Health-related quality of life (QoL) represents important measure of treatment outcome in mental disorders. Numerous studies indicate that QoL of people with schizophrenia and bipolar disorder is similar to that of patients with chronic physical conditions. It has been shown that schizophrenia patients can themselves reliably assess their QoL; in addition to the objective scales various self-reporting instruments are used. Patients with bipolar disorder have QoL consistently higher than patients with schizophrenia and similar to that found in people with unipolar depression. Quality of life can be negatively affected by drug-induced side-effects and subjective treatment response. The second-generation antipsychotics (SGA) have superior efficacy on QoL over classical antipsychotics in approximately half of the studies with schizophrenia; in the other half those groups are comparable. However, in none of the trials novel antipsychotics were inferior. All SGA (clozapine, olanzapine, risperidone, amisulpride, quetiapine, ziprasidone, or remoxipride) have been found to be beneficial for patients well-being. The most investigated drugs that convincingly improve QoL in schizophrenia are olanzapine and risperidone (including depot form). Results of several studies indicate that individual antipsychotics may differ in their effects on QoL, with suggested superiority of olanzapine. In bipolar disorder, SGA consistently showed their superiority over placebo in effects on QoL. The most studied SGA in bipolar disorder is olanzapine. More long-term controlled double-blind trials are needed to definitively uphold superiority and different effects of individual SGA on QoL of patients with schizophrenia and bipolar disorder....

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Journal Article 2001; 22(1): 53-73 PubMed PMID: 11393163 Citation  Keywords:  Adrenal Glands:physiology, Animals, Biological Clocks, Blood Pressure:physiology, Chronobiology Disorders:physiopathology, Chronobiology Phenomena, Chronotherapy, Circadian Rhythm:physiology, Drug Administration Schedule, Genomics, Homeostasis, Humans, Pi.   

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Journal Article 2006; 27(6): 703-710 PubMed PMID: 17187025 Citation  Keywords:  Agonistic Behavior:drug effects, Animals, Arachidonic Acids:pharmacology, Behavior, Animal:drug effects, Cannabinoid Receptor Agonists, Cannabinoid Receptor Antagonists, Central Nervous System Stimulants:administration & dosage, Drug Administration Schedu.   

OBJECTIVES: Psychostimulants and cannabinoids can elicit so called behavioural sensitization after repeated administration, a gradually increased behavioural response to a drug. This phenomenon if conditioned by previous pre-treatment with different drug is termed cross-sensitization. The present study was focused on a possible sensitisation to antiaggressive effect of methamphetamine and cross-sensitization to this effect after repeated pre-treatment with cannabinoid CB1 and CB2 receptor ligands with different intrinsic activity (CB1 agonist methanandamide, CB2 agonist JWH 015, and CB1 antagonist AM 251).

METHODS: Behavioural interactions of singly-housed mice with non-aggressive group-housed partners were video-taped and behavioural elements of agonistic behaviour of isolates were recorded in four categories: sociable, timid, aggressive and locomotor.

RESULTS: Repeated administration of methamphetamine elicited a significant sensitization to its antiaggressive effects. Methanandamide pre-treatment provoked cross-sensitization to this methamphetamine effect, whereas pre-treatment with JWH 015 did not. Combined pre-treatment with methamphetamine+AM 251 suppressed the sensitization to antiaggressive effects of methamphetamine.

CONCLUSIONS: Our findings have shown that it is possible to provoke sensitization not only to the stimulatory effects as stated widespread in the literature but also to inhibitory antiaggressive effects of methamphetamine. Furthermore, we confirmed our working hypothesis that it is possible to elicit either cross-sensitization to inhibitory effects of methamphetamine conditioned by repeated pre-treatment with cannabinoid CB1 receptor agonist methanandamide, or suppression of methamphetamine sensitizing influence by co-administration of CB1 receptor antagonist....

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Journal Article 2006; 27(6): 769-772 PubMed PMID: 17187022 Citation  Keywords:  Adult, Atrophy, Case-Control Studies, Female, Humans, Hypothalamus:pathology, Intracellular Signaling Peptides and Proteins:metabolism, Magnetic Resonance Imaging:instrumentation, Male, Middle Aged, Narcolepsy:metabolism, Neurons:metabolism, Neuropeptides.   

OBJECTIVES: Narcolepsy with cataplexy is associated with a loss of hypocretin. The question is, if there is an autoimmune or neurodegenerative process selectively killing the hypothalamic hypocretin-containing neurons or if these cells survive but fail to produce hypocretin. To support one of these hypothesis we aimed to detect structural changes in the hypothalamus of narcoletic patients.

MATERIALS AND METHODS: Nineteen narcoleptic patients were compared to 16 healthy controls. We used voxel-based morphometry (VBM), an unbiased MRI morphometric method with a high sensitivity for subtle changes in gray and white matter volumes to investigate hypothalamic region in this condition.

RESULTS: Classical MRI protocol revealed no structural abnormalities, but using VBM we found significant reduction in hypothalamic gray matter volumes between patients and controls.

CONCLUSIONS: VBM showed hypothalamic gray matter loss in narcolepsy with cataplexy. This suggest that functional abnormalities of hypocretin neurons in narcolepsy are associated with structural changes of hypothalamus....

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