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Depot neuroleptic maintenance treatment: clinical, pharmacological and neuropsychological aspects

Tuninger, Eva LU (1997)
Abstract (Swedish)
Popular Abstract in Swedish

Underhållsbehandling med neuroleptika minskar risken för nya skov av schizofreni. Ofta har patienter med kronisk psykos bristande sjukdomsinsikt och är därmed dåligt motiverade att följa medicinordinationer (bristande compliance). I sådana fall kan injektionsbehandling med depå-neuroleptika vara ett gott alternativ. Av de 89 patienter som behandlades med depåneuroleptika på en psykiatrisk sektorsmottagning deltog 51 av dem i en treårig uppföljningsstudie. De skattades avseende kliniska symtom och biverkningar. Skattningspoängen analyserades i förhållande till medicindos, plasmakoncentration av det antipsykotiska läkemedlet, resultat av neuropsykologiska tester och bedömning av patientens... (More)
Popular Abstract in Swedish

Underhållsbehandling med neuroleptika minskar risken för nya skov av schizofreni. Ofta har patienter med kronisk psykos bristande sjukdomsinsikt och är därmed dåligt motiverade att följa medicinordinationer (bristande compliance). I sådana fall kan injektionsbehandling med depå-neuroleptika vara ett gott alternativ. Av de 89 patienter som behandlades med depåneuroleptika på en psykiatrisk sektorsmottagning deltog 51 av dem i en treårig uppföljningsstudie. De skattades avseende kliniska symtom och biverkningar. Skattningspoängen analyserades i förhållande till medicindos, plasmakoncentration av det antipsykotiska läkemedlet, resultat av neuropsykologiska tester och bedömning av patientens tillstånd efter 3 och 5 år (graderat som stabilt','försämrat','nytt psykosskov som lett till sjukhusvård' eller 'dödsfall'). Även för de 38 patienter som inte gick med i studien uppskattades tillståndet efter 3 och 5 år med ledning av journaluppgifter. Endast 16/89 patienter förblev kliniskt stabila under den 5-åriga uppföljningstiden. Åtta patienter avled (tre av dem genom självmord) i en medianålder på 47 år. Återfallsfrekvensen var hög även hos äldre patienter.



Dopamin D2 receptor-occupancy mättes hos sex patienter och sex kontroller med SPECT och D2-liganden NCQ298. Syftet med studien var att undersöka om metoden kan utvecklas för kliniskt bruk som hjälp att finna optimal neuroleptikados. Ligand-affiniteten skiljde sig signifikant mellan behandlade patienter och kontroller, vilket tyder på att metoden är användbar, om den utvecklas vidare.



Den aktuella patientgruppen var långsammare på motoriska tester och klarade Digit Span test (test på korttidsminne) sämre än andra patientgrupper. "Kärnschizofreni" var relaterad till en långsammare "tapping"-hastighet i höger hand jämfört med vänster. Intensiteten av hörselhallucinos var negativt korrelerad till "tapping"-hastigheten i höger hand, vilket talar för att vänster hjärnhalva är mer påverkad av sjukdomen i dessa fall. Den påvisade förlångsamningen i vissa motoriska tester kan till en del bero på neuroleptikabiverkningar. (Less)
Abstract
Neuroleptic maintenance treatment is effective to reduce the risk of further episodes of schizophrenia and other chronic psychoses, except affective. Lack of insight often lead to poor compliance to the prescripted medication. Then, neuroleptics might be given as depot injections.



A group of chronic psychotic outpatients were assessed of clinical symptoms and side effects regularely during the three years. Rating scores were analysed in relation to drug doses (in chlorpromazine equivalents), drug plasma level and to performance in a small neuropsychological test battery (Tapping and Alternating tests, Digit Span test, Auditive and Visual Reaction Time tests and two self-rating scales).



Of the 89... (More)
Neuroleptic maintenance treatment is effective to reduce the risk of further episodes of schizophrenia and other chronic psychoses, except affective. Lack of insight often lead to poor compliance to the prescripted medication. Then, neuroleptics might be given as depot injections.



A group of chronic psychotic outpatients were assessed of clinical symptoms and side effects regularely during the three years. Rating scores were analysed in relation to drug doses (in chlorpromazine equivalents), drug plasma level and to performance in a small neuropsychological test battery (Tapping and Alternating tests, Digit Span test, Auditive and Visual Reaction Time tests and two self-rating scales).



Of the 89 depot-treated patients 38 were not eligibble to enter the study. Outcome of the participating 51 patients and of the 38 non-eligible patients was examined in their hospital case records after 3 and 5 years. Only 18% of the 89 patients were stable after 5 years. Eight patients died at a median age of 47 years. Three of them committed suicide. Outcome was significantly worse for the non-eligible patient group (p<.01).



The relapse risk was considerable even after 20 years duration of the illness. Relapse rate was high also in old patients. To reduce the relapse risk, depot neuroleptic doses should be tapered very slowly, maximum once a year and only in steps of 10-20% of the actual dose. The inter-individual variation of optimal doses and drug plasma levels are too large among the patients to define a "therapeutic window" of neuroleptic doses or plasma levels in maintenance treatment. The intraindividual variations of drug plasma levels were considerable and were not associated with side effect ratings.



In a pilot study with a new dopamine D2 ligand, NCQ298, six neuroleptic-treated patients and six controls were examined using SPECT. The aim was to study if the ligand can be used to quantify D2-receptor occupancy. A significant difference in dopamine D2 receptor occupancy was obtained between neuroleptic-treated subjects and controls measured by SPECT, but the method must be more developed before it can be used as a standard method in finding the optimal neuroleptic dose.



Simple motor tests can to some extent be used as an indicator of the rehabilitation potential of chronic psychotic patients. Subjects with prominent negative symptoms had more neuropsychological impairments than others. Patients with core schizophrenia had a markedly slower tapping rate in the right hand compared to the left, suggesting a more marked left-hemisphere disturbance. In patients with auditory hallucinationes tapping rates of especially the right hand correlated negatively to the intensity of hallucinations. Side effects, EPS, may slow performance of some motor tests (Finger Alternation) and also affect the reaction time. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Lindström, Leif
organization
publishing date
type
Thesis
publication status
published
subject
keywords
clinical psychology, Psychiatry, laterality., chronic psychosis, schizophrenia, outcome, maintenance treatment, follow-up, longitudinal, neuropsychology, SPECT, auditory hallucinations, dopamine receptor occupancy, psychosomatics, Psykiatri, klinisk psykologi, psykosomatik
pages
180 pages
publisher
Psychiatry
defense location
MFC, entr. 59, Univerisity Hospital MAS, Malmö
defense date
1997-05-29 10:15
external identifiers
  • Other:ISRN: LUMEDW/MEPM-1005-SE
ISBN
91-628-2461-9
language
English
LU publication?
yes
id
6cc6a94c-ff27-45ec-b23f-2690c3f34940 (old id 29151)
date added to LUP
2007-06-12 14:35:23
date last changed
2016-09-19 08:45:07
@misc{6cc6a94c-ff27-45ec-b23f-2690c3f34940,
  abstract     = {Neuroleptic maintenance treatment is effective to reduce the risk of further episodes of schizophrenia and other chronic psychoses, except affective. Lack of insight often lead to poor compliance to the prescripted medication. Then, neuroleptics might be given as depot injections.<br/><br>
<br/><br>
A group of chronic psychotic outpatients were assessed of clinical symptoms and side effects regularely during the three years. Rating scores were analysed in relation to drug doses (in chlorpromazine equivalents), drug plasma level and to performance in a small neuropsychological test battery (Tapping and Alternating tests, Digit Span test, Auditive and Visual Reaction Time tests and two self-rating scales).<br/><br>
<br/><br>
Of the 89 depot-treated patients 38 were not eligibble to enter the study. Outcome of the participating 51 patients and of the 38 non-eligible patients was examined in their hospital case records after 3 and 5 years. Only 18% of the 89 patients were stable after 5 years. Eight patients died at a median age of 47 years. Three of them committed suicide. Outcome was significantly worse for the non-eligible patient group (p&lt;.01).<br/><br>
<br/><br>
The relapse risk was considerable even after 20 years duration of the illness. Relapse rate was high also in old patients. To reduce the relapse risk, depot neuroleptic doses should be tapered very slowly, maximum once a year and only in steps of 10-20% of the actual dose. The inter-individual variation of optimal doses and drug plasma levels are too large among the patients to define a "therapeutic window" of neuroleptic doses or plasma levels in maintenance treatment. The intraindividual variations of drug plasma levels were considerable and were not associated with side effect ratings.<br/><br>
<br/><br>
In a pilot study with a new dopamine D2 ligand, NCQ298, six neuroleptic-treated patients and six controls were examined using SPECT. The aim was to study if the ligand can be used to quantify D2-receptor occupancy. A significant difference in dopamine D2 receptor occupancy was obtained between neuroleptic-treated subjects and controls measured by SPECT, but the method must be more developed before it can be used as a standard method in finding the optimal neuroleptic dose.<br/><br>
<br/><br>
Simple motor tests can to some extent be used as an indicator of the rehabilitation potential of chronic psychotic patients. Subjects with prominent negative symptoms had more neuropsychological impairments than others. Patients with core schizophrenia had a markedly slower tapping rate in the right hand compared to the left, suggesting a more marked left-hemisphere disturbance. In patients with auditory hallucinationes tapping rates of especially the right hand correlated negatively to the intensity of hallucinations. Side effects, EPS, may slow performance of some motor tests (Finger Alternation) and also affect the reaction time.},
  author       = {Tuninger, Eva},
  isbn         = {91-628-2461-9},
  keyword      = {clinical psychology,Psychiatry,laterality.,chronic psychosis,schizophrenia,outcome,maintenance treatment,follow-up,longitudinal,neuropsychology,SPECT,auditory hallucinations,dopamine receptor occupancy,psychosomatics,Psykiatri,klinisk psykologi,psykosomatik},
  language     = {eng},
  pages        = {180},
  publisher    = {ARRAY(0x81191b0)},
  title        = {Depot neuroleptic maintenance treatment: clinical, pharmacological and neuropsychological aspects},
  year         = {1997},
}