Lege Artis Medicinae

[ANTIPSYCHOTIC DRUGS - A SHORT HISTORY]

BITTER István

NOVEMBER 30, 2004

Lege Artis Medicinae - 2005;15(02 klsz)

[The first drug used as an antipsychotic was chlorpromazine in 1952. The effective drugs after chlorpromazine in the treatment of schizophrenia and acute manic episodes were named as “major tranquillants” then neuroleptic drugs and later as first-generation antipsychotics. The discovery of clozapin has opened a new era in psychiatric therapy which was followed by new antipsychotics with less and less neurological sideeffects. These are called atypical neuroleptics or second generation antipsychotics. The author reviews the path that is characterized by the changes in the naming of these drugs and has led to a situation where clinical recommendations - both in Hungary and internationally - are used to distinguish between the second generation antipsychotics as first or second treatment of choice.]

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Lege Artis Medicinae

[CLINICAL PROFILE, EFFICACY AND SAFETY OF LONG-ACTING INJECTABLE RISPERIDONE]

BÁNKI M. Csaba

[Schizophrenia is a severe and chronic disorder affecting almost 1% of the population worldwide. Antipsychotic drugs, currently in their secondgeneration (atypical) antipsychotics, represent its first-line treatment. Compliance during long-term maintenance pharmacotherapy is one of the key factors in successful patient management; longacting, injectable antipsychotics may significantly contribute to the improvement of the patients The new form of this drug is the first long-acting, injectable second-generation antipsychotic; administered biweekly it produces stable, reliable clinical efficacy. Low peak plasma concentrations and smaller plasma level fluctuations result in excellent tolerance, less side effects than with per os risperidone and minimal local pain due to its specific technology. There is strong evidence from controlled clinical trials for its prolonged efficacy during long-term administration and for patient satisfaction being usually better than with most other antipsychotics. Switching over to long-acting injectable risperidone often results in further improvement even in previously stable patients. No safety concerns have emerged from published evidence. The long-acting injectable risperidone appears to reduce the rehospitalisation rate, a major factor towards its cost-effectiveness.]

Lege Artis Medicinae

[PROBLEMS WITH THE COMPLIANCE OF SCHIZOPHRENIC PATIENTS - CAUSES, CONSEQUENCES AND STRATEGIES FOR ITS MANAGEMENT]

BARTKÓ György

[As many as 80% of patients with schizophrenia have serious problems with the compliance at some point during their course of their treatment. In most cases, patients are partially compliant, taking only a portion of their prescribed medication. Early warning signs of such partial compliance may confuse some clinicians with non-response to treatment and may result in switching these patients to alternative oral antipsychotic drugs. This review focuses on factors that can contribute to partial compliance such as poor insight, negative attitude or subjective response toward medication, cognitive dysfunction, treatment-related side effects, substance abuse and complicated treatment regimen. Partial compliance is among the most common causes of psychotic relapse and the need for rehospitalisation. The reduced incidence of adverse side effects such as extrapyramidal symptoms with atypical antipsychotic agents has the potential to improve compliance in the maintenance treatment of schizophrenia. Administration of a long-acting injectable antipsychotic provides confirmation of whether patients have taken their medication. Furthermore, it allows physicians to distinguish non-response and non-compliance. Strategies for managing partial compliance include the use of a long-acting injectable atypical antipsychotic, psychoeducation and cognitive-behavioural interventions.]

Lege Artis Medicinae

[SUCCESSFUL TREATMENT WITH LONG-ACTING INJECTABLE RISPERIDONE]

TÉNYI Tamás

[INTRODUCTION - In the past 15 years new antipsychotic drugs have come forward with higher efficacy in the treatment of schizophrenia. These new medications are safer and have less side-effects. It is now established that longacting maintenance therapy is favourable than intermittent therapy CASE PRESENTATION - The author introduces the case of a male schizophrenic patient who was hospitalized three times over ten years. He discontinued maintenance therapy because of lack of symptoms first time, then because of severe side-effects and then he stopped seeing his psychiatrist. However after a new acute episode his treatment was changed to longacting injectable risperidone with a success. With maintenance therapy the patient is now symptom-free and went back to work. CONCLUSION - Continuous long-acting injectable therapy proved to be successful in the prevention of symptom recurrence and with its application patient compliance has improved and smaller doses have become sufficient to maintain stedy-state.]

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