Combining depot antipsychotic with an assertive monitoring programme for treating first‐episode schizophrenia in a resource‐constrained setting

Chiliza, Bonginkosi; Ojagbemi, Akin; Esan, Oluyomi; Asmal, Laila; Oosthuizen, Piet; Kidd, Martin; Gureje, Oye; Emsley, Robin

doi:10.1111/eip.12141

Cited by 22 publications

(22 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is an important finding as a recent study conducted in the Western Cape has shown that low dose depot FGA together with assertive monitoring programmes may be a safe and effective intervention for patients with first episode psychosis. 17 Further studies at this hospital could aim to examine the use of antipsychotic drugs in the first episode of psychosis.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic use in a resource-limited setting: Findings in an Eastern Cape psychiatric hospital

2017

View full text Add to dashboard Cite

BackgroundSecond-generation antipsychotics (SGAs) are commonly prescribed despite the fact that large, naturalistic studies have failed to show superior efficacy and tolerability when compared with first-generation antipsychotics (FGAs). In addition to this, the availability of SGAs in the South African public health sector is limited because of higher acquisition costs. Therefore, judicious use of FGAs, which are affordable and more widely available, should be considered.AimsThis study aimed to (1) determine how frequently patients are switched from an FGA to an SGA in an acute psychiatric hospital in the Eastern Cape, (2) determine reasons for switching and (3) compare the profiles of the switch group to the non-switch group.MethodThe study is a cross-sectional survey conducted as a retrospective chart review at a psychiatric hospital in the Eastern Cape over a study period of 2 months. The demographics, diagnostic data, antipsychotic drug used and whether a switch from an FGA to an SGA took place were recorded using a data collection document. The sample included 169 patients.ResultsOf the 169 patients, 125 (74%) were initiated on an FGA and 44 (26%) on an SGA on admission. Of the 125 patients who were initiated on an FGA, 43 (34%) were switched to an SGA during the course of the admission. Therefore, 87 (51%) participants were discharged on an SGA. The main reasons for switching were the emergence of extrapyramidal side-effects (EPSE) (63%) followed by lack of efficacy (19%). The only statistically significant difference between the switch and non-switch groups was that the switch group was on average younger than the non-switch group.ConclusionSGAs, with the exception of clozapine, have not been proven to be superior to FGAs. Although FGAs are more prone to cause EPSE, SGAs carry significant risks of their own. FGAs are also more freely available and cost effective in South-Africa. Despite these facts the prescribing of and switching to SGAs remain prevalent in our setting with a switch rate of 34% and more than half of our patients being discharged on SGAs.

show abstract

Section: Discussionmentioning

confidence: 99%

Antipsychotic use in a resource-limited setting: Findings in an Eastern Cape psychiatric hospital

2017

View full text Add to dashboard Cite

show abstract

“…The primary outcome is symptom severity as assessed with the PANSS score. Based on our previous naturalistic follow-up study of patients with psychosis undergoing treatment [ 37 ], we estimate that a mean difference of 7.5 units on the total PANSS outcome scores between the two arms will represent a clinically significant difference (given that a standard deviation of 20 was obtained for the PANSS in that study). With the target effect size of 0.38, an uninflated sample size of 112 patients per arm will be required to provide a power of 80% and at an alpha of 0.05.…”

Section: Method/designmentioning

confidence: 99%

COllaborative Shared care to IMprove Psychosis Outcome (COSIMPO): study protocol for a randomized controlled trial

Gureje

Kola

Yusuf

et al. 2017

Trials

Self Cite

View full text Add to dashboard Cite

BackgroundPsychotic disorders are a group of severe mental disorders that cause considerable disability to sufferers and a high level of burden to families. In many low- and middle-income countries (LMIC), traditional and faith healers are the main providers of care to affected persons. Even though frequently canvassed as desirable for improved care delivery, collaboration between these complementary alternative health providers (CAPs) and conventional health providers has yet to be rigorously tested for feasibility and effectiveness on patient outcomes.Methods/designCOSIMPO is a single-blind, cluster randomized controlled trial (RCT) being conducted in Nigeria and Ghana to compare the effectiveness of a collaborative shared care (CSC) intervention program implemented by CAPs and primary health care providers (PHCPs) with care as usual (CAU) at improving the outcome of patients with psychosis. The study is designed to test the hypotheses that patients receiving CSC will have a better clinical outcome and experience fewer harmful treatment practices from the CAPs than patients receiving CAU at 6 months after study entry. An estimated sample of 296 participants will be recruited from across 51 clusters, with a cluster consisting of a primary care clinic and its neighboring CAP facilities. CSC is a manualized intervention package consisting of regular and scheduled visits of PHCPs to CAP facilities to assist with the management of trial participants. Assistance includes the administration of antipsychotic medications, management of comorbid physical condition, assisting the CAP to avoid harmful treatment practices, and engaging with CAPs, caregivers and participants in planning discharge and rehabilitation. The primary outcome, assessed at 6 months following trial entry, is improvement on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes, assessed at 3 and 6 months, consist of levels of disability, experience of harmful treatment practices and of victimization, and levels of perceived stigma and of caregivers’ burden.DiscussionInformation about whether collaboration between orthodox and complementary health providers is feasible and can lead to improved outcome for patients is important to formulating policies designed to formally engage the services of traditional and faith healers within the public health system.Trial registrationNational Institutes of Health Clinical Trial registry, ID: NCT02895269. Registered on 30 July 2016Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2187-x) contains supplementary material, which is available to authorized users.

show abstract

“…The authors identified an increased content of specific genomic insertions in synaptic genes in affected subjects and three of these elements are placed in the intronic region of GRM3 , GRM5 and GRM7 . Beside case-control experimental studies, NGS methods have been applied in SCZ also to analyze drug treatment response, identifying no connection between GRMs and antipsychotic effect [ 74 ].…”

Section: Insights From Next Generation Sequencing Studiesmentioning

confidence: 99%

The Role of Metabotropic Glutamate Receptor Genes in Schizophrenia

Maj

Minelli

Giacopuzzi

et al. 2016

View full text Add to dashboard Cite

Genomic studies revealed two main components in the genetic architecture of schizophrenia, one constituted by common variants determining a distributed polygenic effect and one represented by a large number of heterogeneous rare and highly disruptive mutations. These gene modifications often affect neural transmission and different studies proved an involvement of metabotropic glutamate receptors in schizophrenia phenotype. Through the combination of literature information with genomic data from public repositories, we analyzed the current knowledge on the involvement of genetic variations of the human metabotropic glutamate receptors in schizophrenia and related endophenotypes. Despite the analysis did not reveal a definitive connection, different suggestive associations have been identified and in particular a relevant role has emerged for GRM3 in affecting specific schizophrenia endophenotypes. This supports the hypothesis that these receptors are directly involved in schizophrenia disorder.

show abstract

Combining depot antipsychotic with an assertive monitoring programme for treating first‐episode schizophrenia in a resource‐constrained setting

Abstract: Combination of depot antipsychotic with an AMP may be an effective and safe intervention in early phases of schizophrenia, and may be particularly suitable for resource-constrained settings.

Cited by 22 publications

References 52 publications

Antipsychotic use in a resource-limited setting: Findings in an Eastern Cape psychiatric hospital

Antipsychotic use in a resource-limited setting: Findings in an Eastern Cape psychiatric hospital

COllaborative Shared care to IMprove Psychosis Outcome (COSIMPO): study protocol for a randomized controlled trial

The Role of Metabotropic Glutamate Receptor Genes in Schizophrenia

Contact Info

Product

Resources

About