Quetiapine is a second‐generation antipsychotic. Second‐generation or atypical antipsychotic drugs have become the mainstay of treatment in many countries for people with schizophrenia. They are called second‐generation drugs because they are newer than the older drugs, known as typical antipsychotics. Second‐generation drugs are thought to be better than the older drugs in reducing the symptoms of schizophrenia, such as hearing voices and seeing things, and are suggested to produce fewer side effects, such as sleepiness, weight gain, tremors and shaking. However, it is not clear how the various second‐ generation antipsychotic drugs differ from one other. The aim of this review therefore was to evaluate the effects of quetiapine compared with other second‐generation antipsychotic drugs for people with schizophrenia. The review included a total of 35 studies with 5971 people, which provided information on six comparisons (quetiapine vs the following: clozapine, olanzapine, risperidone, ziprasidone, paliperidone and aripiprazole). Comparisons with amisulpride, sertindole and zotepine do not exist, so more research is needed. A major limitation of all findings was the large number of people leaving studies and stopping quetiapine treatment (50.2% of people). The most important finding to note is that if a group is started on quetiapine, most will be off this drug within a few weeks (although the reasons for stopping quetiapine treatment are not covered by the review and so remain uncertain). Quetiapine may be slightly less effective than risperidone and olanzapine in reducing symptoms, and it may cause less weight gain and fewer side effects and associated problems (such as heart problems and diabetes) than olanzapine and paliperidone, but more than are seen with risperidone and ziprasidone. The limited information tends to suggest that people taking quetiapine may need to be hospitalised more frequently than those taking risperidone or olanzapine. This may lead to higher costs in some settings, but the information is not robust enough to guide managers.
Friday 6 December 2013
Psychosocial interventions for people with both severe mental illness and substance misuse
‘Dual diagnosis’ is the term used to describe people who have a mental health problem and also have problems with drugs or alcohol. In some areas, over 50% of all those with mental health difficulties will have problems with drugs or alcohol. For people with mental illness, substance misuse often has a negative and damaging effect on the symptoms of their illness and the way their medication works. They may become aggressive or engage in activities that are illegal. Substance misuse can also increase risk of suicide, hepatitis C, HIV, relapse, incarceration and homelessness.
People who have substance misuse problems but no mental illness can be treated via a variety of psychosocial interventions. These include motivational interviewing, or MI, that looks at people’s motivation for change; cognitive behavioural therapy, or CBT, which helps people adapt their behaviour by improving coping strategies; a supportive approach similar to that pioneered by Alcoholics Anonymous; family psycho‐education observing the signs and effects of substance misuse; and group or individual skills training. However, using these interventions for people with dual diagnosis is more complex.
The aim of this review was to assess the effects of psychosocial interventions for substance reduction in people with a serious mental illness compared to care as usual or standard care. A search for studies was carried out in July 2012; 32 studies were included in the review with a total of 3165 people. These studies used a variety of different psychosocial interventions (including CBT, MI, skills training, integrated models of care). In the main, evidence was graded as low or very low quality and no study showed any great difference between psychosocial interventions and treatment as usual. There was no compelling evidence to support any one psychosocial treatment over another. However, differences in study designs made comparisons between studies problematic. Studies also had high numbers of people leaving early, differences in outcomes measured, and differing ways in which the psychosocial interventions were delivered. More large scale, high quality and better reported studies are required to address these shortcomings. This will better address whether psychosocial interventions are effective and good for people with mental illness and substance misuse problems.
People who have substance misuse problems but no mental illness can be treated via a variety of psychosocial interventions. These include motivational interviewing, or MI, that looks at people’s motivation for change; cognitive behavioural therapy, or CBT, which helps people adapt their behaviour by improving coping strategies; a supportive approach similar to that pioneered by Alcoholics Anonymous; family psycho‐education observing the signs and effects of substance misuse; and group or individual skills training. However, using these interventions for people with dual diagnosis is more complex.
The aim of this review was to assess the effects of psychosocial interventions for substance reduction in people with a serious mental illness compared to care as usual or standard care. A search for studies was carried out in July 2012; 32 studies were included in the review with a total of 3165 people. These studies used a variety of different psychosocial interventions (including CBT, MI, skills training, integrated models of care). In the main, evidence was graded as low or very low quality and no study showed any great difference between psychosocial interventions and treatment as usual. There was no compelling evidence to support any one psychosocial treatment over another. However, differences in study designs made comparisons between studies problematic. Studies also had high numbers of people leaving early, differences in outcomes measured, and differing ways in which the psychosocial interventions were delivered. More large scale, high quality and better reported studies are required to address these shortcomings. This will better address whether psychosocial interventions are effective and good for people with mental illness and substance misuse problems.
Pimozide for schizophrenia or related psychoses
People with schizophrenia have ‘positive symptoms’ such as hearing voices and seeing things (hallucinations) and fixed strange beliefs (delusions). People with schizophrenia also have ‘negative symptoms’ such as tiredness, apathy and loss of emotion. Antipsychotic drugs are the main treatment for the symptoms of schizophrenia and can be grouped into older drugs (first generation or ‘typical’) and newer drugs (second generation or ‘atypical’). Pimozide is a ‘typical’ antipsychotic drug that was first introduced in the late 1960s and was given to people with schizophrenia. Pimozide is thought to be effective in treating the positive and negative symptoms of schizophrenia or similar mental health problems such as delusional disorder, but it produces serious side effects such as muscle stiffness, tremors and slow body movements. Pimozide may also cause heart problems and has been linked to sudden unexplained death. Monitoring the heart via electrocardiogram is now required before and during treatment with pimozide. It is well known that people with mental health problems suffer from physical illnesses such as heart disease and diabetes and can die on average twenty years younger than those in the general population.
An update search for this review was carried out 28 January 2013; the review now includes 32 studies that assess the effects of pimozide for people with schizophrenia or similar mental health problems. Pimozide was compared with other antipsychotic drugs, placebo (‘dummy’ treatment) or no treatment. Results suggest that pimozide is probably just as effective as other commonly used ‘typical’ antipsychotic drugs (for outcomes such as treating mental state, relapse, leaving the study early). No studies included delusional disorders, so no information is available on this group of people. No evidence was found to support the concern that pimozide causes heart problems (although this may be result of the fact that the studies were small and short term and the participants did not receive doses above recommended limits of 20 mg/d). Pimozide may cause less sleepiness than other typical antipsychotic drugs, but it may cause more tremors and uncontrollable shaking. The claim that pimozide is useful for treating people with negative symptoms also is not supported and proven. However, the quality of evidence in the main was low or very low quality, studies were small and of short duration and were poorly reported. Large‐scale, well‐conducted and well‐reported studies are required to assess the effectiveness of pimozide in the treatment of schizophrenia and other mental health problems such as delusional disorder.
An update search for this review was carried out 28 January 2013; the review now includes 32 studies that assess the effects of pimozide for people with schizophrenia or similar mental health problems. Pimozide was compared with other antipsychotic drugs, placebo (‘dummy’ treatment) or no treatment. Results suggest that pimozide is probably just as effective as other commonly used ‘typical’ antipsychotic drugs (for outcomes such as treating mental state, relapse, leaving the study early). No studies included delusional disorders, so no information is available on this group of people. No evidence was found to support the concern that pimozide causes heart problems (although this may be result of the fact that the studies were small and short term and the participants did not receive doses above recommended limits of 20 mg/d). Pimozide may cause less sleepiness than other typical antipsychotic drugs, but it may cause more tremors and uncontrollable shaking. The claim that pimozide is useful for treating people with negative symptoms also is not supported and proven. However, the quality of evidence in the main was low or very low quality, studies were small and of short duration and were poorly reported. Large‐scale, well‐conducted and well‐reported studies are required to assess the effectiveness of pimozide in the treatment of schizophrenia and other mental health problems such as delusional disorder.
Haloperidol versus placebo for schizophrenia
Haloperidol was first developed in the late 1950s. Research subsequently showed its therapeutic effects on the symptoms of schizophrenia, such as hearing voices and seeing things (hallucinations), having strange beliefs (delusions), aggressiveness, impulsiveness and states of excitement. This led to the introduction of haloperidol as one of the first antipsychotic drugs. Antipsychotic drugs are the main treatment for the symptoms of schizophrenia. Despite the introduction of newer antipsychotic drugs (second generation or ‘atypical’ drugs), haloperidol remains in widespread use and is the benchmark for judging the effectiveness of newer antipsychotic drugs.
The aim of this review was to evaluate the effects of haloperidol for schizophrenia and other similar serious mental illnesses compared with ‘dummy’ or no treatment (placebo). A new search for trials was carried out in May 2012 and the review now includes 25 studies with a total of 4651 people. Review authors rated the quality of evidence reported in the trials for seven main outcomes (global state, death, discharge from hospital, relapse, leaving the study early, adverse effects and satisfaction with treatment). For global state, leaving the study early and adverse effects the reviewers rated the evidence as moderate quality, however, relapse and discharge from hospital were rated to be very low quality evidence. There were no data available for death and satisfaction with treatment.
Based on moderate quality evidence, haloperidol was found to be better than placebo in treating schizophrenia. More people given haloperidol improved in the first six weeks of treatment than those given placebo. However, a significant number of people on haloperidol suffered from side effects, including muscle stiffness, uncontrollable shaking, tremors, sleepiness and restlessness.
Authors concluded that haloperidol is a potent and effective antipsychotic for treating the symptoms of schizophrenia but has the potential to cause debilitating side effects. People with schizophrenia and psychiatrists may wish to prescribe a newer antipsychotic drug with fewer side effects.
Finally, a large proportion of other information and data in the trials were poor and badly reported, meaning that better studies are required. Many people, from both groups left the trials early. This suggests that the design and running of the trials was poor and perhaps not acceptable to people. In light of these findings, it is perhaps surprising that haloperidol is a benchmark antipsychotic in widespread use for treating schizophrenia. It is also surprising that haloperidol is widely used as a comparison for new medication. Haloperidol is an effective antipsychotic drug but has serious and debilitating side effects.
The aim of this review was to evaluate the effects of haloperidol for schizophrenia and other similar serious mental illnesses compared with ‘dummy’ or no treatment (placebo). A new search for trials was carried out in May 2012 and the review now includes 25 studies with a total of 4651 people. Review authors rated the quality of evidence reported in the trials for seven main outcomes (global state, death, discharge from hospital, relapse, leaving the study early, adverse effects and satisfaction with treatment). For global state, leaving the study early and adverse effects the reviewers rated the evidence as moderate quality, however, relapse and discharge from hospital were rated to be very low quality evidence. There were no data available for death and satisfaction with treatment.
Based on moderate quality evidence, haloperidol was found to be better than placebo in treating schizophrenia. More people given haloperidol improved in the first six weeks of treatment than those given placebo. However, a significant number of people on haloperidol suffered from side effects, including muscle stiffness, uncontrollable shaking, tremors, sleepiness and restlessness.
Authors concluded that haloperidol is a potent and effective antipsychotic for treating the symptoms of schizophrenia but has the potential to cause debilitating side effects. People with schizophrenia and psychiatrists may wish to prescribe a newer antipsychotic drug with fewer side effects.
Finally, a large proportion of other information and data in the trials were poor and badly reported, meaning that better studies are required. Many people, from both groups left the trials early. This suggests that the design and running of the trials was poor and perhaps not acceptable to people. In light of these findings, it is perhaps surprising that haloperidol is a benchmark antipsychotic in widespread use for treating schizophrenia. It is also surprising that haloperidol is widely used as a comparison for new medication. Haloperidol is an effective antipsychotic drug but has serious and debilitating side effects.
Dance therapy for schizophrenia.
The first line of treatment of schizophrenia is usually antipsychotic drugs. Usually, these drugs are more effective in treating the 'positive symptoms' than 'negative symptoms' of schizophrenia. Moreover, antipsychotic drugs have debilitating side‐effects such as weight gain, shaking, tremors and muscle stiffness.
Dance therapy (also known as dance movement therapy, DMT) uses movement and dance to explore a person’s emotions in a non‐verbal way (without language or words). The therapist helps the individual to interpret their dance and movement and link them with people’s personal feelings. Dance has been used as a healing ritual since earliest human history, but the establishment of dance therapy as a profession is quite recent. Dance therapy can be used with people of all ages, races and genders. It can be effective in the treatment of people with medical, social, developmental, physical and psychological impairments. The review included one study with 45 participants. The aim was to compare dance therapy with standard care or other interventions. The one included study compared dance therapy plus routine care with routine care alone. In the main, there was no difference between those who engaged in dance therapy versus those who did not (for outcomes such as satisfaction with care, mental state, leaving the study early, quality of life). However, those who engaged in dance therapy showed significant improvement in negative symptoms.
Overall, because of the small number of participants, the findings are limited. There is little evidence to support or refute the use of dance therapy. Larger studies and trials are needed that focus on important outcomes (such as rates of relapse, quality of life, admission to hospital, leaving the study early, cost of care and satisfaction with treatment). Further research would help clarify whether dance therapy is an effective and holistic treatment for people with schizophrenia, especially in terms of helping people cope with negative symptoms that do not respond so well to antipsychotic drugs.
Dance therapy (also known as dance movement therapy, DMT) uses movement and dance to explore a person’s emotions in a non‐verbal way (without language or words). The therapist helps the individual to interpret their dance and movement and link them with people’s personal feelings. Dance has been used as a healing ritual since earliest human history, but the establishment of dance therapy as a profession is quite recent. Dance therapy can be used with people of all ages, races and genders. It can be effective in the treatment of people with medical, social, developmental, physical and psychological impairments. The review included one study with 45 participants. The aim was to compare dance therapy with standard care or other interventions. The one included study compared dance therapy plus routine care with routine care alone. In the main, there was no difference between those who engaged in dance therapy versus those who did not (for outcomes such as satisfaction with care, mental state, leaving the study early, quality of life). However, those who engaged in dance therapy showed significant improvement in negative symptoms.
Overall, because of the small number of participants, the findings are limited. There is little evidence to support or refute the use of dance therapy. Larger studies and trials are needed that focus on important outcomes (such as rates of relapse, quality of life, admission to hospital, leaving the study early, cost of care and satisfaction with treatment). Further research would help clarify whether dance therapy is an effective and holistic treatment for people with schizophrenia, especially in terms of helping people cope with negative symptoms that do not respond so well to antipsychotic drugs.
Quetiapine versus typical antipsychotic drugs for schizophrenia.
Antipsychotic drugs are the main treatment for schizophrenia, helping to treat both the positive symptoms (such as hearing voices, seeing things and having strange beliefs) and negative symptoms (including apathy, tiredness and loss of emotion) of this illness. Selecting the most effective antipsychotic drug that can be tolerated by people with schizophrenia is crucial to successful treatment. Older drugs (also known as typical or first generation antipsychotic drugs), such as chlorpromazine and haloperidol, have been used in treating schizophrenia for over 50 years. Although these older drugs are good at treating the positive symptoms of schizophrenia they tend to cause undesirable side effects. These side effects can mean that people do not tolerate or like taking these drugs, which may lead to relapse and admission to hospital. Since 1988, a newer generation of antipsychotic drugs has become available. These new drugs (known as atypical or second generation antipsychotic drugs) are effective in treating the symptoms of schizophrenia but thought to have less side effects than older drugs. However, although newer drugs may cause less side effects such as movement disorders, they have been linked to other side effects like heart problems or weight gain. Quetiapine is a new antipsychotic drug for schizophrenia that has been available for over a decade. However, it is not clear how the effects of quetiapine differ from older antipsychotic drugs. This review evaluated the effectiveness and tolerability of quetiapine versus older antipsychotic drugs. The review included 43 trials with a total of 7217 people. Most studies were from China. In the main, quetiapine did not differ from older drugs for the treatment of positive symptoms of mental illness. There were also no clear differences in terms of the treatment of negative symptoms. However, it is important to note that evidence from these trials suggests quetiapine causes fewer side effects (such as weight gain, dizziness, movement disorders, the inability to sit still, shaking, tremors and abnormal levels of the hormone prolactin, which can contribute to sexual and mental health problems). However, evidence from the trials is limited due to high numbers of people leaving early in almost all of the studies. More evidence through the completion of well designed studies comparing quetiapine with older antipsychotic drugs is needed.
Collaborative care approaches for people with severe mental illness.
Collaborative care aims to improve the physical and mental health of people with severe mental illness (SMI). Common to all definitions is that collaborative care aims to develop closer working relationships between primary care (family doctors or GPs and practice nurses) and specialist health care (such as Community Mental Health Teams). There are different ways in which this can be achieved, making collaborative care very complex. Integrating or joining‐up primary care and mental health services, so that they work better together, is intended to increase communication and joint working between health professionals (e.g. GPs, psychiatrists, nurses, pharmacists, psychologists). This is meant to provide a person with severe mental illness with better care, based in the community, which is often a less stigmatised setting than hospital, and that promotion of good practice helps consumers maintain contact with services. A major issue is that many GPs still feel that physical health problems (such as diabetes, heart disease, smoking cessation) are more their concern and see treatment of severe mental illness as the job of psychiatrists and other mental health professionals. Collaborative care aims to improve overall quality of care by ensuring that healthcare professionals work together, trying to meet the physical and mental health needs of people. The aim of the review was to assess the effectiveness of collaborative care in comparison to standard or usual care. An electronic search for trials was carried out in April 2011. The primary focus of interest was admissions to hospital. According to the one included study in this review, collaborative care may be effective in reducing going into hospital (less psychiatric admissions and other admissions). It also helps improve people’s quality of life and mental health. However, all evidence was either low or very low quality and further research is needed to determine whether collaborative care is good for people with SMI in terms of clinical outcomes or helping people feel better as well as its cost effectiveness.
Subscribe to:
Posts (Atom)