Predictors of antipsychotic medication adherence in patients recovering from a first psychotic episode Adherence to conventional and atypical antipsychotics after hospital discharge. The risks and benefits of switching patients with schizophrenia or schizoaffective disorder from two to one antipsychotic medication: A randomized controlled trial Evidence-based recommendations for monitoring safety of second-generation antipsychotics in children and youth. Longer time to antipsychotic treatment discontinuation for any cause is associated with better functional outcomes for patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder. Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care. Maintenance treatment with long-acting injectable risperidone in first-episode schizophrenia: a randomized effectiveness study. Effectiveness and tolerability of oral ziprasidone in psychiatric inpatients with an acute exacerbation of schizophrenia or schizoaffective disorder: a multicenter, prospective, and naturalistic study. Attitude toward antipsychotic medication as a predictor of antipsychotic treatment discontinuation in first-episode early-onset psychosis. First do no harm: promoting an evidence-based approach to atypical antipsychotic use in children and adolescents. Remission in patients with first-episode schizophrenia receiving assured antipsychotic medication: a study with risperidone long-acting injection Effectiveness of maintenance treatments with atypical and typical antipsychotics in stable schizophrenia with early stage: 1-year naturalistic study Psychoeducation Improves Compliance and Outcome in Schizophrenia Without an Increase of Adverse Side Effects: A 7-Year Follow-up of the Munich PIP-Study. The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder Oral versus Long-Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Special Populations at Risk for Treatment Nonadherence: A Systematic Review L-theanine relieves positive, activation, and anxiety symptoms in patients with schizophrenia and schizoaffective disorder: an 8-week, randomized, double-blind, placebo-controlled, 2-center study. Effectiveness of switching to ziprasidone for stable but symptomatic outpatients with schizophrenia. Cost-effectiveness of risperidone, olanzapine, and conventional antipsychotic medications. Subjective response and attitudes toward antipsychotic drug therapy during the initial treatment period: a prospective follow‐up study in patients with schizophrenia Use of concomitant medication with antipsychotic treatment in outpatients with schizophrenia: Results from the European Schizophrenia Outpatients Health Outcomes (SOHO) study Reasons for discontinuation and continuation of antipsychotics in the treatment of schizophrenia from patient and clinician perspectives A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia Antipsychotic medication for childhood-onset schizophrenia.
BACKGROUND Many patients recovering from a first psychotic episode will discontinue medication against medical advice , even before a 1-year treatment course is completed . Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment , treatment with typical versus atypical antipsychotic and medication side effects . METHOD In this 2-year prospect i ve study of 254 patients recovering from a first episode of schizophrenia , schizophreniform , or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about : need for treatment , antipsychotic medication benefits , and negative aspects of antipsychotic medication treatment . We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine , and objective measures of symptom response and side effects . RESULTS The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less ( HR=1.75 , 95 % CI 1.16 , 2.65 , p=0.0077 ) or who believed medications were of low benefit ( HR=2.88 , 95 CI 1.79 - 4.65 , p<0.0001 ) . Subjects r and omized to haloperidol were more likely to become medication non-adherent for > or=1 week than subjects r and omized to olanzapine ( HR-1.51 , 95 % CI 1.01 , 2.27 , p=0.045 ) . CONCLUSION Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia , schizoaffective , or schizophreniform disorder BACKGROUND This prospect i ve study measured adherence to conventional and atypical antipsychotics after hospital discharge in patients with a diagnosis of schizophrenia and schizoaffective disorder . We examined the interaction of several predictors such as gender , severity of illness , attitudes toward medications , side effects , and dose frequency . METHOD The sample consisted of consecutive r and omized and nonr and omized patients who were discharged from an inpatient unit with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder between December 1995 and July 1999 . All patients were taking oral antipsychotics  and consented to the use of an electronic adherence monitor at discharge . Medications were prescribed by usual care providers , and medication adherence was followed weekly for 3 months . The outcome measure was the medication adherence rate registered in the electronic monitors . RESULTS We found no significant difference in adherence between the combined groups of atypical and conventional antipsychotics . Individual medication analysis found better medication adherence with olanzapine in comparison with risperidone and conventional antipsychotics , but the difference disappeared in the final model controlling for dose frequency . Dose frequency , gender , and akathisia predicted adherence . CONCLUSIONS Olanzapine initially appeared to be associated with an adherence advantage over risperidone and conventional antipsychotics , but the apparent advantage may have been due to a usual care dose frequency practice that associated olanzapine more often with once-daily dosing . This study suggests that dose frequency is an important predictor of medication adherence . An important caveat is that these results apply only to short-term adherence BACKGROUND Despite little evidence to support its use and practice guidelines discouraging the practice , antipsychotic polypharmacy is widely prevalent in schizophrenia . This r and omized controlled trial studied the effects of switching patients stable on two antipsychotic medications  to one antipsychotic medication . METHOD 104 adult out patients with schizophrenia from 7 community mental health centers clinical ly stable on concurrent treatment with 2 antipsychotics  were r and omly assigned to stay on polypharmacy or to switch to antipsychotic monotherapy . Participants were followed for 1-year with assessment s of symptoms and side effects occurring every 60days ( 7 total assessment s ) . We examined differences in time trajectories in symptoms ( PANSS , CGI ) and side effects ( EPS , metabolic , other ) as a function of group assignment ( switch vs. stay ) and time , using intention-to-treat analysis . RESULTS Participants who switched to antipsychotic monotherapy experienced greater increases in symptoms than stay patients . These differences emerged in the second 6months of the trial . All-cause discontinuation rates over the 1-year trial were higher in the switch-to-monotherapy group than in the stay-on-polypharmacy group ( 42 % vs. 13 % ; p<0.01 ) . There were no differences in change over time in any of the side effect measures , except that stay patients experienced a greater decrease in Simpson Angus total scores than switch patients . CONCLUSION Clinicians should be cautious in switching patients with chronic schizophrenia who are stable on 2 antipsychotics to one antipsychotic . Given the challenges in discontinuing antipsychotic polypharmacy , adequate trials of evidence -based treatments such as clozapine and long-acting injectable antipsychotics should be undertaken in inadequately responsive schizophrenia patients before moving to antipsychotic polypharmacy BACKGROUND The use of antipsychotics , especially second-generation antipsychotics ( SGAs ) , for children with mental health disorders in Canada has increased dramatically over the past five years . These medications have the potential to cause major metabolic and neurological complications with chronic use . OBJECTIVE To synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children , and provide evidence -based recommendations for the monitoring of these side effects . METHODS A systematic review of controlled clinical trials of SGAs involving children was performed . Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE ( Grading of Recommendations Assessment , Development and Evaluation ) system . When there was inadequate evidence , recommendations were based on consensus and expert opinion . A multidisciplinary consensus group review ed all relevant evidence and reached consensus on the recommendations . RESULTS The present guidelines provide evidence -based recommendations for monitoring SGA safety . The strength of recommendations for specific physical examination manoeuvres and laboratory tests are provided for each SGA medication at specific time points . CONCLUSION Multiple r and omized controlled trials evaluated the efficacy of many of the SGAs in paediatric mental health disorders . These benefits , however , are not without risks - both metabolic and neurological side effects occur in children treated with SGAs . The risk of weight gain , increased body mass index and abnormal lipid levels is greatest with olanzapine , followed by clozapine and quetiapine . The risk of neurological side effects of the treatment is greatest with risperidone , olanzapine and aripiprazole . Appropriate monitoring procedures for adverse effects will improve the quality of care of children treated with these medications OBJECTIVE Time to all-cause treatment discontinuation is considered a composite proxy measure of treatment efficacy , safety , and tolerability . Longer time to discontinuation of antipsychotic medication for any cause has been shown to be associated with greater symptom improvements in the treatment of schizophrenia . This study examines whether longer time to all-cause medication discontinuation is also linked to better functional outcomes . METHOD Using pooled data from 4 r and omized , double-blind antipsychotic trials of 24- to 28-weeks ' duration , this study examined the association between time to all-cause treatment discontinuation and functional outcomes , as assessed by a disease-specific , clinician-rated measure ( Quality of Life Scale [ QLS ] ) and a generic , patient-reported measure ( Medical Outcomes Study Short Form 36 [ SF-36 ] ) . Patients in these trials had a DSM-IV diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder . This post hoc analysis used Pearson partial correlations to assess relationships between time to treatment discontinuation and changes in functional scores , adjusting for baseline scores . Repeated measures analyses were also conducted to compare post-baseline functional outcome change over time between completers and noncompleters . RESULTS Longer time to all-cause treatment discontinuation was found to be significantly associated with greater improvements in all assessed functional domains ( p < .05 ) . Patients who completed their respective trials ( 46.8 % , 761/1627 ) experienced significantly greater improvement in functional outcome measures ( in 4 QLS domains and SF-36 mental health component summary score ; all , p < .001 ) compared to patients who discontinued for any cause . In addition , greater symptom improvement was significantly associated with greater functional improvements in assessed domains . CONCLUSIONS Findings from this post hoc analysis illustrate the importance of longer treatment duration with antipsychotics for improving functional outcomes in the treatment of patients with schizophrenia BACKGROUND Relatively little is known about the relationships between medication adherence and long-term functional outcomes in the treatment of schizophrenia . To extend previous research , we prospect ively examined the relationships between adherence with any antipsychotic medication and functional outcomes among schizophrenia patients treated over a 3-year period , assessed the stability of adherence over time , and examined whether adherence in the first year predicts changes in functional outcomes over the following 2 years . METHOD Analyses included 1906 participants with DSM-IV diagnoses of schizophrenia or schizoaffective or schizophreniform disorder in a multi-site , 3-year , prospect i ve , naturalistic study conducted in the United States between July 1997 and September 2003 . Outcome measures were assessed at 6-month intervals using systematic medical record abstract ion and structured interview of patients . Adherence with antipsychotic regimen was assessed using patient-reported adherence and the medication possession ratio ( percent days with prescription for any antipsychotic ) , dichotomized into adherence and non-adherence . Analyses employed generalized estimating equations and mixed models with repeated measures . RESULTS Nonadherence was associated with poorer functional outcomes , including greater risks of psychiatric hospitalizations , use of emergency psychiatric services , arrests , violence , victimizations , poorer mental functioning , poorer life satisfaction , greater substance use , and more alcohol-related problems ( all p < .001 ) . Adherence was relatively stable , with 77.3 % of patients maintaining the same adherence status from the first year to the second year . Nonadherence in the first year predicted significantly poorer outcomes in the following 2 years . CONCLUSIONS Findings highlight the importance of adherence with antipsychotic medication in the long-term treatment of schizophrenia and its potential beneficial impact on the mental health and criminal justice delivery systems BACKGROUND Because long-acting injectable ( LAI ) antipsychotics are largely reserved for persistently ill patients , little is known about the use of LAIs early in the course of illness for first-episode out patients . METHOD A prospect i ve , open-label , r and omized controlled trial was conducted in which out patients with first-episode DSM-IV schizophreniform disorder , schizophrenia , or schizoaffective disorder were enrolled from December 2004 to March 2007 . Participants were r and omly assigned at a 2:1 ratio to a recommendation of changing to LAI risperidone microspheres ( RLAI ) ( n = 26 ) or continuing oral antipsychotic treatment ( n = 11 ) for up to 104 weeks . Primary outcomes were time until initial nonadherence ( medication gap of ≥ 14 days ) and medication attitudes as assessed with the Rating of Medication Influences scale . Patients r and omly assigned to an RLAI recommendation could decline the recommendation , so analysis defined treatment groups by intent-to-treat and as-actually-treated . RESULTS Eighty-one percent of patients ( 30/37 ) stopped medication within 104 weeks . There was a trend toward an initial adherence benefit favoring RLAI acceptors at 12 weeks ( P = .058 ) , but no significant difference between RLAI and oral antipsychotic treatment in time to initial nonadherence during the overall study ( P = .188 ) . Medication attitudes did not differ between groups . CONCLUSIONS Acceptance of RLAI was associated with an initial adherence benefit that was not sustained over time . Early introduction of LAI therapy did not adversely affect adherence attitudes . The small size of the study and low power limit interpretation , but the few patients who remained adherent into a second year were all receiving RLAI . Nonadherence was almost universal in our first-episode cohort , but nonadherence was more easily detected among first-episode patients treated with LAI therapy than it was with oral antipsychotics . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00220714 OBJECTIVE This prospect i ve , uncontrolled , and naturalistic study aim ed to evaluate the effectiveness and tolerability of oral ziprasidone in psychiatric in patients with an acute exacerbation of schizophrenia or schizoaffective disorder treated in the clinical practice setting . METHOD Patients had to be at least 18 years old and meet DSM-IV-TR criteria for acute exacerbation of schizophrenia or schizoaffective disorder . Patients were followed until discharge and were evaluated with the Brief Psychiatric Rating Scale ( BPRS ) , Clinical Global Impressions ( CGI ) scale , Drug Attitude Inventory , and the Scale to Assess Unawareness of Mental Disorder .  Ziprasidone dose requirements , dose escalation , discontinuation of treatment , and the use of any concomitant medication including cotreatment with other antipsychotics were established individually according to the clinical judgment of each investigator . The study was conducted from February 2005 to June 2007 . RESULTS We included a total of 196 patients ( intent-to-treat population ) , 9 ( 5 % ) of whom discontinued treatment with ziprasidone ( 3 because of side effects ) . The mean ( SD ) length of stay was 23.4 ( 34.2 ) days . The mean ( SD ) dose at discharge was 186.3 ( 67.6 ) mg/day , and the median dose was 160 mg/day ( interquartile range , 120 - 240 mg/day ) . Response rates at the endpoint , according to BPRS and CGI criteria , were 74 % ( 95 % CI = 68 % to 80 % ) and 67 % ( 95 % CI = 61 % to 74 % ) , respectively . Progressive and statistically significant improvements in all BPRS scores and CGI-Severity of Illness scores were observed from the first week through discharge . All changes from baseline to the study endpoint for BPRS and CGI scores were clinical ly relevant , with effect sizes greater than 0.80 . The insight into illness and the attitude toward medication also improved significantly over the course of the study . Ziprasidone was well tolerated . CONCLUSION Although our results should be interpreted with caution because of the uncontrolled design of our study , they suggest that , in acutely ill in patients with schizophrenia or schizoaffective disorder , the use of ziprasidone under routine clinical conditions is associated with a rapid and progressive improvement in psychopathologic symptoms and a clinical ly relevant improvement in insight into their illness BACKGROUND Antipsychotic drug discontinuation is a key risk factor in psychotic relapses . Clinical relapse is related to poor outcome , especially in the earlier stages of psychotic illness . The attitude toward treatment during the acute phase of a first episode of psychosis has been proposed as one of the main determinants of treatment discontinuation . However , the relationship between attitude toward antipsychotic medication and treatment discontinuation in the adolescent population has not been properly assessed . METHODS Adolescents , aged 12 - 18 years old , consecutively admitted to an adolescent unit with a first lifetime admission for a first episode of psychosis were asked to participate in a r and omized , flexible-dose , 6-month controlled trial of olanzapine vs. quetiapine .  Attitude toward antipsychotic medication  was assessed using the 10-item Drug Attitude Inventory ( DAI ) . The outcome variable was all-cause treatment discontinuation over the 6-month follow- up . The study sample was composed of 42 patients [ 34 boys ( 82.9 % ) , eight girls ( 17.1 % ) , mean age ± SD : 16.1±1.3 ] . RESULTS Of the 42 patients , only 29 ( 69 % ) continued the medication throughout the entire 6-month follow-up , while 13 ( 31 % ) discontinued the medication . DAI scores were greater than zero at all assessment s , indicating that the general attitude of the patients toward medication was positive . Higher DAI scores at baseline were related to lower all-cause treatment discontinuation [ adjusted hazard ratio ( HR ) = 0.81 ( 95 % CI : 0.68 - 0.96 ) , P=0.016 ] , while DAI scores at 15 days were unrelated to treatment discontinuation [ adjusted HR=1.0 ( 95 % CI : 0.82 - 1.23 ) , P=0.998 ] . CONCLUSIONS A better attitude toward antipsychotic medication at a first lifetime psychiatric admission for a first early-onset psychotic episode was significantly related to lower all-cause antipsychotic treatment discontinuation OBJECTIVES To review the evidence for efficacy and metabolic effects of atypical antipsychotics ( AAPs ) , and to propose a metabolic monitoring protocol for AAP use in children and adolescents . METHODS A PubMed search was performed to obtain all studies related to efficacy , metabolic side-effects , and monitoring in those less than 18 years of age . RESULTS There are no approved indications for AAP use in children and adolescents in Canada . Based on US Food and Drug Administration approvals and a review of r and omized controlled trials , we identified 7 indications for AAP use that target specific symptoms in youth including schizophrenia , bipolar I disorder , autism , pervasive developmental disorder , disruptive behaviour disorders ( including conduct disorder and ADHD ) , developmental disabilities and Tourette Syndrome . A wide range of metabolic effects including weight gain , increased waist circumference , dysglycemia , dyslipidemia , hypertension , elevated hepatic transaminases and prolactin levels have been reported . We have developed a proposal for metabolic monitoring that includes anthropometric measurements and laboratory testing at baseline and appropriate intervals thereafter . CONCLUSION There is an urgent need for national clinical practice guidelines that provide , not only appropriate treatment algorithms for AAP-use based on evidence , but also address metabolic monitoring and subsequent management of complications in this vulnerable population Recently proposed criteria for remission by a ‘ Remission in Schizophrenia Working Group ’ have generated considerable interest . We assessed rates , predictors , and correlates of remission in a sample of patients with first-episode schizophrenia treated with injectable , long-acting risperidone .  This allowed us to examine remission among patients known to be receiving medication . This was a single-site open-label study in which 50 newly diagnosed cases of schizophreniform disorder or schizophrenia aged 16 to 43 years were treated with injectable , long-acting risperidone 25–50 mg every 2 weeks for 2 years . Remission , according to Remission in Schizophrenia Working Group criteria , was achieved in 64 % of the patients . Of those achieving remission , 97 % maintained this status until study completion . Remission was associated with greater improvements in other symptom domains , insight , and social and occupational functioning . Patients in remission received lower doses of antipsychotic medication , had fewer extrapyramidal symptoms , and a more favorable attitude toward medication . The results of this open-label study suggest that a majority of first-episode patients who receive long-acting injectable  antipsychotic medication may achieve sustained remission . Double-blind-controlled studies using long-acting injectable antipsychotics in early psychosis are warranted to further test this Rationale The relative effectiveness of the atypical antipsychotic drugs and conventional agents in patients with early-stage schizophrenia has not been comprehensively determined . Objectives The aim of our study was to evaluate the efficacy and safety of seven antipsychotic drugs for the maintenance treatment in patients with early-stage schizophrenia . Methods In a 12-month open-label , prospect i ve observational , multicenter study , 1,133 subjects with schizophrenia or schizophreniform disorder within 5 years of onset were monotherapy with chlorpromazine , sulpiride , clozapine , risperidone , olanzapine , quetiapine , or aripiprazole . The primary measure was the rate of treatment discontinuation for any reason . Secondary outcomes included measures for clinical and functional outcomes and tolerability . Results The percentage of patients discontinued treatment within 12 months was 41.4 % for chlorpromazine , 39.5 % for sulpiride , 36.7 % for clozapine , 40.2 % for risperidone , 39.6 % for olanzapine , 46.9 % for quetiapine , and 40.2 % for aripiprazole , a nonsignificant difference ( p = 0.717 ) ; there were no significant differences among these seven treatments on discontinuation due to relapse , intolerability , patient decision , or nonadherence ( all p values ≥ 0.260 ) . Extrapyramidal symptoms were more prominent in chlorpromazine and sulpiride treatment groups . Anticholinergic side effects were most common with clozapine and chlorpromazine . Weight gain was most common with olanzapine and clozapine . Conclusions The efficacy of seven antipsychotic medications for the maintenance treatment appeared similar in early-stage schizophrenia . With regard to the high dropout rate and side effects , special programs are needed to keep efficacy and safety of antipsychotics maintenance treatment for schizophrenia with early Psychoeducation improves adherence and motivates patients to accept a maintenance therapy as recommended by the guidelines . This would mean a daily consumption of at least 300 chlorpromazine ( CPZ ) units in the long run and should lead to an increase of the antipsychotic dosage in comparison to patients with treatment as usual ( TAU ) . This raises 2 important questions : whether more side effects are provoked and do the patients have a corresponding benefit with a better outcome . A total of 41 patients with a diagnosis of schizophrenic or schizoaffective disorder were r and omized at study entry , either to bifocal psychoeducation ( 21 ) , or to st and ard treatment  ( 20 ) . They were compared concerning compliance , type of medication , dosage ( CPZ equivalents ) , motor side effects and number of days in hospital . The average daily antipsychotic medication  2 and 7 years after index discharge was 365 and 354 CPZ-units respectively in the intervention group ( IG ) , but 247 and 279 , respectively in the control group ( CG ) . The extent of motor side effects was slightly smaller in the IG , but they showed a small and statistically not significant increase in the rate of tardive dyskinesia ( TD ) after 7 years . At the 7-year follow-up the patients in the IG had spent 74.7 days in hospital compared to 243.4 days for the patients in the CG ( P < .05 ) . The course of illness was significantly better in the IG without increasing motor side-effects . Therefore , psychoeducation should be integrated more systematic ally into the routine treatment . These data are part of a previous study , published 2007 , with a sample size of 48 patients . Seven patients -3 of the IG and 4 of the CG-could not be included , because they were not able to complete the very complex " Computer-based kinematic analysis of motor performance . " In this article all conclusions are referred to the new sample size , therefore some results are slightly different in comparison to the previous data Among out patients with schizophrenia , antipsychotic non-adherence is common , grossly under-detected by patients and their prescribers , and is associated with poor clinical outcomes . Using electronic monitoring ( EM ) as the reference st and ard we evaluated the reliability and validity as well as the sensitivity and specificity of a recently developed , brief , pencil-paper , clinician-administered adherence instrument [ the Brief Adherence Rating Scale ( BARS ) ] to assess the oral antipsychotic medication adherence of out patients with schizophrenia and schizoaffective disorder .  EM and BARS adherence and symptom severity ratings were gathered at baseline and prospect ively at 6 monthly visits in 61 participants ( n=35 with schizophrenia ; n=26 with schizoaffective disorder ) . A significant positive relationship was found between mean BARS and EM adherence ( beta=0.98 ; rs=0.59 , p<0.0001 ) . Cronbach 's coefficient alpha revealed very high internal reliability for the BARS ( alpha=0.92 ) . A moderate-to-strong degree of test-retest reliability was also found for the BARS ( beta ranged from 0.53 to 0.92 and rs ranged from 0.46 to 0.86 ) . Regarding concurrent validity of the BARS , greater mean  BARS adherence was significantly related to lower mean PANSS total scores ( beta=-0.40 ; rs=-0.39 , p=0.002 ) and to lower mean Positive symptom sub-scale scores ( beta=-0.08 , p=.007 ; rs=-0.28 , p=.02 ) . An initial 3-month monitoring period with the BARS also demonstrated good sensitivity ( 73 % ) and specificity ( 74 % ) in identifying non-adherent out patients ( defined as < 70 % mean EM adherence ) . Relative to EM , the BARS appears to provide valid , reliable , sensitive , and specific estimates of antipsychotic medication adherence of out patients with schizophrenia and schizoaffective disorder . The BARS appears to be a promising c and i date as a brief adherence assessment instrument for feasible use in community-based setting Long-acting injectable antipsychotics ( LAIs ) should offer better efficacy and tolerability , compared to oral antipsychotics due to improved adherence and more stable pharmacokinetics . However , data on LAIs has been mixed , with some studies finding that they are more effective and tolerable than oral antipsychotics , and others finding the contrary . One possibility for the disparate results may be that some studies administered different antipsychotics in the oral and injectable form . The present systematic review examined the efficacy and tolerability of LAIs versus their oral equivalents in r and omized and naturalistic studies . In addition , it examined the impact of LAIs  on special population s such as patients with first-episode psychosis , substance use disorders , and a history of violence or on involuntary outpatient commitment . R and omized studies suggest that not all LAIs are the same ; for example , long-acting risperidone may be associated with equal or less side effects than oral risperidone , whereas fluphenazine decanoate and enanthate may be associated with equal or more side effects than oral fluphenazine . They also suggest that LAIs reduce risk of relapse versus oral antipsychotics in schizophrenia out patients when combined with quality psychosocial interventions . For their part , naturalistic studies point to a larger magnitude of benefit for LAIs , relative to their oral equivalents particularly among first-episode patients OBJECTIVE L-theanine is a unique amino acid present almost exclusively in the tea plant . It possesses neuroprotective , mood-enhancing , and relaxation properties . This is a first study design ed to evaluate the efficacy and tolerability of L-theanine augmentation of antipsychotic treatment of patients with chronic schizophrenia and schizoaffective disorder . METHOD 60 patients with DSM-IV schizophrenia or schizoaffective disorder participated in an 8-week , double-blind , r and omized , placebo-controlled study . 400 mg/d of L-theanine was added to ongoing antipsychotic treatment from February 2006 until October 2008 . The outcome measures were the Positive and Negative Syndrome Scale ( PANSS ) , the Hamilton Anxiety Rating Scale ( HARS ) , the Cambridge Neuropsychological Test Automated Battery ( CANTAB ) for neurocognitive functioning , and additional measures of general functioning , side effects , and quality of life . RESULTS 40 patients completed the study protocol . Compared with placebo , L-theanine augmentation was associated with reduction of anxiety ( P = .015 ; measured by the HARS scale ) and positive ( P = .009 ) and general psychopathology ( P < .001 ) scores ( measured by the PANSS 3-dimensional model ) . According to the 5-dimension model of psychopathology , L-theanine produced significant reductions on PANSS positive ( P = .004 ) and activation factor ( P = .006 ) scores compared to placebo . The effect sizes ( Cohen d ) for these differences ranged from modest to moderate ( 0.09 - 0.39 ) . PANSS negative and CANTAB task scores , general functioning , side effect , and quality of life measures were not affected by L-theanine augmentation . L-theanine was found to be a safe and well-tolerated medication . CONCLUSIONS L-theanine augmentation of antipsychotic therapy can ameliorate positive , activation , and anxiety symptoms in schizophrenia and schizoaffective disorder patients . Further long-term studies of L-theanine are needed to substantiate the clinical ly significant benefits of L-theanine augmentation BACKGROUND Many out patients with schizophrenia experience persistent symptoms or side effects on their current antipsychotic regimen . Few studies have prospect ively examined the effects of the prior medication or switching method on the safety and efficacy of a newly available antipsychotic . Efficacy and tolerability of ziprasidone were evaluated in patients with DSM-IV schizophrenia or schizoaffective disorder who were switched from conventional or atypical antipsychotics in three 6-week , multicenter , r and omized , open-label , parallel-group trials . METHOD Stable out patients with persistent symptoms or troublesome side effects on ( 1 ) conventional antipsychotic ( N = 108 ) , ( 2 ) olanzapine ( N = 104 ) , or ( 3 ) risperidone ( N = 58 ) therapy were switched to an open-label , 6-week , flexible-dose trial of ziprasidone ( 40 - 160 mg/day ) . Patients were r and omly assigned at baseline to 1 of 3 switching schedules during the first week of ziprasidone therapy . Baseline and outcome assessment s included Positive and Negative Syndrome Scale ( PANSS ) and Clinical Global Impressions of Severity ( CGI-S ) ratings . RESULTS All 3 switching strategies were well tolerated for all 3 patient groups . After 6 weeks on ziprasidone therapy , significant ( p < .05 ) improvements were observed on all major symptom measures and almost all subscales for all switched subgroups . CONCLUSION Switching stable but symptomatic out patients from their previous antipsychotic to ziprasidone was generally well tolerated and was associated with symptom improvements 6 weeks later . Improvements occurred in patients recently on other first-line atypical antipsychotic , as well as in those on conventional antipsychotic , treatment . While limitations of switching study design s do not permit interpretation of comparative efficacy , these studies suggest that out patients who partially respond to conventional antipsychotics , risperidone , or olanzapine  may experience improved control of psychotic symptoms following a switch to ziprasidone To assess the cost and effectiveness of risperidone , olanzapine , and conventional antipsychotic medications under " usual practice " conditions in a large , public mental health system , 108 persons diagnosed with schizophrenia or schizoaffective disorder were r and omly assigned to one of these three medication groups and followed prospect ively over a 12-month period using st and ard instruments and procedures . Psychiatric medication costs increased more over time in both the olanzapine and risperidone groups than in the conventional medication group . Compliance with the prescribed medication was higher in the olanzapine group than in the conventional group . No differential effects by medication group were evident in this sample on the symptoms of schizophrenia , side effects , psychosocial functioning , time to discharge for index hospitalization , survival to initial rehospitalization , or client satisfaction with services . These results extend findings from previous efficacy and naturalistic studies in several ways but are limited chiefly by the small number of subjects who completed 6 to 12 months of the clinical trial , and the result ing power to detect differences in the statistical analyses Objective : In this prospect i ve study , patients with schizophrenia were followed up for 3 months to investigate the impact of sociodemographic factors , psychopathology , change in psychopathology and side effects on subjective response and attitudes toward antipsychotics  during the initial treatment period Use of concomitant medications with antipsychotic agents in the treatment of schizophrenia is common but lacks a clear scientific rationale . We evaluated concomitant medication usage during the first 6 months of the prospect i ve , observational , European Schizophrenia Outpatient Health Outcomes ( SOHO ) study , examining its frequency , variation according to type of antipsychotic drug used , and impact on treatment tolerability . We also determined factors that were associated with concomitant medication use . The use of concomitant medications differed greatly among the countries participating in the SOHO study . The presence of depressive symptoms and being female were associated with the use of concomitant antidepressants . Certain antipsychotics were associated with less use of concomitant medications : significantly fewer olanzapine- , quetiapine- and clozapine-treated patients used concomitant anticholinergics or anxiolytics/hypnotics .  Patients using concomitant medications had an increased incidence of sexually related side effects and extrapyramidal side effects ( EPS ) at 6 months follow-up compared with patients not using concomitant medications . The results should be interpreted conservatively due to the observational design of SOHO Abstract Objective : To identify reasons for discontinuation and continuation of antipsychotic medications in the treatment of schizophrenia from the patients ’ and their clinicians ’ perspectives . Research design and methods : Two measures were previously developed to assess the Reasons for Antipsychotic Discontinuation/Continuation ( RAD ) , one from the patient 's perspective and another from the clinician 's perspective . These measures were administered to acutely ill schizophrenia patients enrolled in a 12-week study of antipsychotic medications ( N = 596 ) and to their clinicians . The RAD was assessed at baseline and at endpoint . Reasons were rated on a 5-point scale from ‘ primary reason ’ to ‘ not a reason . ’ The single most important reason was also identified . The ‘ single most important reason ’ and the ‘ primary reasons ’ for discontinuing the drug used prior to enrollment , and for discontinuing or continuing the study drug were identified . Levels of concordance between patients ’ and clinicians ’ reasons were assessed . Clinical trial registration : The data source for this study is a clinical trial registered at www . clinical trials.gov ( NCT00337662 ) . Main outcome measures : Reasons for Antipsychotic Discontinuation/Continuation ( RAD ) . Results : Patients and clinicians identified several reasons for medication discontinuation and continuation ( 2.3 to 6.3 reasons , on average ) . The top ‘ single most important ’ reason for discontinuing the drug used prior to enrollment and for discontinuing the study drug was ‘ positive symptoms not sufficiently improved or made worse , ’ followed by ‘ medication-related adverse events . ’ The most frequent ‘ single most important ’ reason for medication continuation was ‘ improved positive symptoms , ’ followed by ‘ patient 's perception of improvement , ’ and ‘ functional improvement . ’ A high level of concordance was observed between patients ’ and clinicians ’ ratings . Conclusions : Medication efficacy appears to be the core driver of medication discontinuation and continuation , especially with regard to positive symptoms . There was a high level of concordance between patients ’ and clinicians ’ perspectives . Limitations include the study requirement that patients be at least moderately ill and experiencing acute psychotic exacerbation , a potential selection bias in the readiness to respond to measures , and small sample sizes for some analyses . Further research is needed to replicate findings in patients who are not acutely ill BACKGROUND The aim of this study was to assess the impact of a short message service (SMS)-based strategy on adherence to antipsychotic treatment . METHODS A multicentre , r and omised , open-label , controlled , 6-month study with clinical ly stabilised out patients with schizophrenia was conducted . The patients assigned to the intervention received daily SMS reminders to take their medication for 3 months . Self-reported medication adherence was determined using the Morisky Green Adherence Question naire ( MAQ ) . Secondary outcomes were severity of illness , attitude towards medication , insight into illness and health-related quality of life . RESULTS A total of 254 patients were analysed . A significantly greater improvement in adherence was observed among patients receiving SMS text messages compared with the control group . The mean change in MAQ total score from baseline to month 3 was -1.0 ( 95 % confidence interval ( CI ) -1.02 , -0.98 ) and -0.7 ( 95%CI -0.72 , -0.68 ) , respectively ( P=0.02 ) . Greater improvement in negative , cognitive and global clinical symptoms at month 3 was observed . Attitude towards medication also significantly improved across the study in the intervention group versus the controls . CONCLUSIONS An SMS-based intervention seems feasible and acceptable for enhancing medication adherence . Further studies are needed to confirm whether this kind of intervention could be a complementary strategy to optimise adherence in schizophrenia BACKGROUND : Childhood-onset schizophrenia is schizophrenia with onset prior to the age of 13 years . Although it is rare , people who suffer from schizophrenia at an early age appear to have a clinical ly severe form of the illness with poor long-term prognosis . Antipsychotic medication is one way of managing this rare but serious mental illness . OBJECTIVES : To examine the effects of antipsychotic medication for childhood-onset schizophrenia . SEARCH STRATEGY : We search ed the Cochrane Schizophrenia Group Trials Register ( November 2006 and February 2007 ) , inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors of trials for additional information . SELECTION CRITERIA : We included all r and omised clinical trials involving children and young people with a diagnosis of childhood onset schizophrenia ( i.e. with a diagnosis of schizophrenia before the age of 13 ) comparing any antipsychotic drug with another antipsychotic or placebo . DATA COLLECTION AND ANALYSIS : We reliably selected , quality assessed and extracted data from trials . We excluded data where more than 50 % of participants in any group were lost to follow up . For homogenous dichotomous data we calculated r and om effects , relative risk ( RR ) and its 95 % confidence interval ( CI ) and , where appropriate , number needed to treat ( NNT ) on an intention-to-treat basis . For normal continuous data we calculated the weighted mean difference ( WMD ) . MAIN RESULTS : From a total of 2062 citations , we identified six relevant trials . We categorised trials into three comparisons : atypical versus typical , atypical versus atypical and typical versus typical antipsychotic drugs . The only comparison to find any differences between treatment groups was atypical versus typical antipsychotic drugs . A few results from one study favoured the atypical antipsychotic clozapine over haloperidol in treating treatment resistant childhood-onset schizophrenia ( n=21 , WMD CGAS 17.00 CI 7.74 to 26.26 ; n=21 , WMD Bunney-Hamburg Psychosis Rating Scale -3.60 CI -6.64 to -0.56 ) . Participants on clozapine , however , were three times more likely to have drowsiness ( 1 RCT , n=21 , RR 3.30 CI 1.23 to 8.85 , NNH 2 CI 2 to 17 ) and half of the children receiving clozapine had neutropenia ( 1 RCT , n=21 , RR 12 , CI 0.75 to 192.86 ) . AUTHORS ' CONCLUSIONS : There are few relevant trials and , presently , there is little conclusive evidence regarding the effects of antipsychotic medication for those with early onset schizophrenia . Some benefits were identified in using the atypical antipsychotic clozapine compared with haloperidol but the benefits were offset by an increased risk of serious adverse effects . Larger , more robust , trials are required
CONCLUSIONS This review provides some support to the notion that patients experiencing antipsychotic side-effects are at risk of developing more negative attitudes toward medication .
BACKGROUND Antipsychotics are associated with a wide range of side-effects .
Many patients experience antipsychotics as unpleasant and something they would rather avoid , leading some of them to discontinue taking their medication .
The importance of evaluating the patients ' perspective , especially their attitudes toward medication in the presence of side-effects , has long been emphasized .
However , no definite conclusion has been made to date on the relationship between antipsychotic side-effects and attitudes toward medication .
OBJECTIVES The objective of this systematic review was to determine the best available evidence regarding the impact of antipsychotic side-effects on attitudes toward medication in patients with schizophrenia and related disorders , which include schizoaffective and schizophreniform disorders .
SEARCH STRATEGY The search aim ed to find published studies using a range of data bases .