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Biomedical subjects

J Peuskens

Publications and source records attributed to J Peuskens.

At least 19 recordsLinked to original sources
PubMed2003

The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial.

OBJECTIVE: To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept. DESIGN: Randomized controlled parallel-group trial with repeated measures. SETTING: Three treatment units of a university psychiatric hospital in Belgium. SUBJECTS: One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders. INTERVENTIONS: A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks. OUTCOME MEASURES: The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile. RESULTS: After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values < 0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness (p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept (p from 0.01 to < 0.0001). However, these improvements were not related to the progress in physical fitness. CONCLUSIONS: The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.

Adult↗
PubMed2002

Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related?

OBJECTIVE: The aim of this study was to investigate whether the characteristics of residents and professional caregivers are associated with the professionals' expressed emotion (EE). METHOD: Fifty-six residents in sheltered living who suffer from schizophrenia or a related psychotic disorder and their professional caregivers were enlisted. Standardised validated instruments were used to measure EE, the residents' social functioning, symptoms and social network size, and the professional caregivers' coping strategies and personality. RESULTS: There was strong evidence that high EE was associated with the residents' age, poorer social functioning and smaller network sizes. There was no significant relationship between EE and the residents' symptoms except for excitement. Concerning the professional caregivers, high EE professionals were less open than their low EE colleagues and had a lower education level. CONCLUSION: The residents' social functioning is an important correlate of the EE index.

Adaptation, Psychological↗
PubMed2002

Amisulpride improves depressive symptoms in acute exacerbations of schizophrenia: comparison with haloperidol and risperidone.

The Brief Psychiatric Rating Scale (BPRS) anxiety/depression subscore has been used to assess affective symptoms in three studies (n = 612) comparing amisulpride (400-800 mg/day, n = 339) with haloperidol (15-20 mg/day, n = 160) and risperidone (8 mg/day, n = 113) in the treatment of acute exacerbations of schizophrenia. At endpoint, the mean improvement in the anxiety/depression subscore showed a significant (P = 0.011) difference in favour of amisulpride (5.6+/-6.1) compared with haloperidol (4.4+/-5.5) and risperidone (3.7+/-4.7). Amisulpride provided a significantly greater improvement compared both to haloperidol and risperidone in more severely depressed patients (BPRS anxiety/depression subscore > or = 16 at baseline, P = 0.001). This significant advantage in favour of amisulpride is seen from the 2nd week of treatment.

Adult↗
PubMed2002

Switching to amisulpride.

The introduction of atypical antipsychotics represents an important advance in the treatment of schizophrenia. As their therapeutic efficacy, tolerability and safety profiles are clearly superior to classical neuroleptics, atypical antipsychotic agents are considered to be the treatment of choice in first episode patients. In addition, an increasing number of patients are being switched from classical to atypical antipsychotic agents. Switching is especially relevant in patients with a poor therapeutic response to classical neuroleptics and persistent symptoms (positive symptoms, negative symptoms, depressive syndromes, cognitive deficit); in patients with a psychotic relapse despite compliance; in patients with important side-effects (not only acute and tardive extrapyramidal symptoms [EPS] and general side-effects, but also dysphoria or neuroleptic-induced deficit syndrome [NIDS]); and in patients who are non-compliant due to side-effects. Switching to atypical antipsychotics should be performed with extreme care in stabilised patients; or in patients who present a danger to themselves or others at relapse; or in patients who are on depot neuroleptics who were non-compliant to previous oral treatment. Switching requires careful planning to reduce the risk of withdrawal effects (neuroleptic withdrawal syndrome, cholinergic rebound, exacerbation of symptoms or relapse, rebound of parkinsonism, dystonia, akathisia, dyskinesia), which may mask the beneficial effects and lead to early discontinuation of the new treatment. Patients, family and carers should be actively involved at all stages, and educated about the possible benefits and problems associated with switching therapy. Cross-tapering old and new treatment is the preferred method for switching and this involves tapering off the previous antipsychotic agent and any adjunctive treatment (sedatives, anticholinergic medication), while gradually titrating the new atypical antipsychotic agent to the established therapeutic dose. Switching patients to amisulpride treatment offers effective antipsychotic therapy, with a positive effect on negative and depressive symptoms. Amisulpride treatment also results in improved quality of life and social functioning in addition to fewer relapses and days of hospitalisation during long-term follow-up.

Amisulpride↗
PubMed2001

Risk factors for suicide in young people suffering from schizophrenia: a long-term follow-up study.

Ten per cent of patients with schizophrenia commit suicide, but assessment of risk is difficult. Large case-control studies with a long follow-up period are needed. These should focus on patients from one age group to give clinicians the details required to identify those at highest risk.We present a case-control study of 63 patients who committed suicide and 63 controls from a consecutive admission series of patients with a diagnosis of schizophrenia. All patients were under the age of 30 at admission.Risk factors for suicide were male gender, chronic illness with frequent relapses (OR 6.0), frequent short hospitalisation, a negative attitude towards treatment (OR non-compliance 7.0), impulsive behaviour (OR acting out 6.4, OR involuntary commitment 17), parasuicide (OR suicide attempt 4.8, OR highly lethal suicide attempt 11), high pre-morbid IQ (OR 4.3), psychosis (OR 7.0) and depression (OR 36). However, early onset of a defect state (OR 6.3) and a daily activity (OR 4.2) were protective factors. Identified risk factors could help clinicians to target high-risk patients and form the basis for interventions aimed at reducing suicide.

Adult↗
PubMed2001

Expressed emotion in staff-patient relationships: the professionals' and residents' perspectives.

BACKGROUND: Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE. METHODS: EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. RESULTS: Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. CONCLUSIONS: The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.

Adult↗
PubMed2000

Effects of risperidone on affective symptoms in patients with schizophrenia.

The effects of risperidone on affective symptoms were determined by an analysis of pooled data from six double-blind trials of risperidone versus haloperidol in 1254 patients with chronic schizophrenia. Symptoms indicating mania were assessed by the Positive and Negative Syndrome Scale (PANSS) excitement and grandiosity items and by the excited cluster (excitement, hostility, uncooperativeness, and poor impulse control); anxious / depressive symptoms were assessed by the PANSS anxious / depressive cluster (somatic concern, anxiety, guilt feelings, and depression). Mean change scores from baseline to endpoint were compared in patients receiving risperidone, haloperidol or placebo by analysis of variance with factors for trial and baseline score included in the model. In all patients, change scores on excitement and grandiosity items and excited and anxious / depressive clusters were significantly greater for risperidone than for haloperidol or placebo. Dropouts due to inefficacy were less frequent with risperidone (5 of 59; 8%) than with haloperidol (7 of 38; 18%) or placebo (8 of 10; 80%). In patients with anxious / depressive symptoms at baseline (anxiety / depression cluster score > or = the median), anxiety / depression scores decreased significantly more with risperidone than with haloperidol, and symptom reduction occurred faster with risperidone. These results are consistent with previous reports and suggest that risperidone is more efficacious than haloperidol for affective symptoms in patients with schizophrenia.

Adolescent↗
PubMed2000

Switching approach in the management of schizophrenia patients.

Atypical neuroleptics combine efficacy with good tolerability. As a result, prognosis and quality of life may improve when patients receiving treatment with traditional agents are switched to an atypical compound. Major indications for switching are lack of or incomplete response to classical neuroleptic treatment, and/or the occurrence of extrapyramidal symptoms. The previous treatment should be discontinued, preferably progressively, and the new one started, overlapping the previous treatment. Caution is advised in patients who have suffered a recent relapse, a severe psychotic episode or who are being treated as outpatients. Anticholinergic medication, if needed, should be continued for 2-4 weeks after the switch has been made. The physician should be aware of the potential drug interactions leading to increased sedation or hypotension. Patient education is vital when switching medications. Treatment should be individualized. Patients who have gained weight on previous therapy, or who have negative symptoms of schizophrenia and depressive symptoms, are particularly likely to benefit from amisulpride. Furthermore, the highly selective affinity of amisulpride for dopaminergic receptors with its lack of interference with other neurotransmitter systems facilitates the change in treatment.

Antipsychotic Agents↗
PubMed1999

Amisulpride vs. risperidone in the treatment of acute exacerbations of schizophrenia. Amisulpride study group.

Amisulpride, a substituted benzamide with high selectivity for dopamine D3 and D2 receptors, was compared with the antipsychotic risperidone in patients with acute exacerbations of schizophrenia. The study was double-blind and involved 228 patients allocated, after a 3-6-day wash-out period, to amisulpride 800 mg (n = 115) or risperidone 8 mg (n = 113) for 8 weeks. Both treatments produced a marked improvement in schizophrenic symptomatology. Decreases in mean BPRS total score were 17.7 +/- 14.9 for amisulpride and 15.2 +/- 13.9 for risperidone, and all of the individual factors on the BPRS showed a numerically greater improvement in the amisulpride than in the risperidone patients. Both treatments were equally effective against positive symptoms on the PANSS positive syndrome subscale; however, there was a trend in favor of greater improvement in negative symptoms assessed on the PANSS negative subscale in patients receiving amisulpride with a decrease of 6.9 +/- 7.5 vs. 5.3 +/- 6.6 for risperidone (P = 0.09). Both drugs demonstrated good safety profiles, and scores on neurological scales (SAS, AIMS, and BAS) did not increase during treatment. A comparable proportion of patients received antiparkinsonian medication, 30 and 23% in the amisulpride and risperidone groups, respectively (P = 0.21). Patients receiving risperidone experienced an increase in body weight, which was significantly greater than for amisulpride (P = 0.026).

Acute Disease↗
PubMed1999

The evolving definition of treatment resistance.

Despite the introduction of antipsychotic treatment for schizophrenia, the outcome for many patients has remained poor. This is largely due to the treatment-resistant nature of schizophrenia in some patients and inadequate long-term maintenance treatment. The definition of treatment resistance remains controversial in spite of its importance. This review discusses the importance of treatment resistance and the factors affecting its definition in the light of recent advances in knowledge and treatment. A decade ago, positive symptoms were thought to be the prime outcome measure for schizophrenia and were the standard by which treatment resistance was largely assessed. More recently, however, a wider range of outcome measures has been recognized, including both negative symptoms and cognitive function. All of these outcome measures affect quality of life such that the patient may consider any outcome other than a return to premorbid levels of functioning as inadequate. Furthermore, patient responsiveness should be recognized as a continuum rather than as a dichotomy of response or nonresponse; partial response to treatment may not be accepted as satisfactory. Definitions of treatment resistance should reflect these factors. Patients may benefit from pharmacotherapy with atypical antipsychotics even if they do not meet criteria for narrowly defined treatment resistance. Although clozapine use has often been restricted to treatment-resistant patients, the benefit it bestows outweighs the potential risk of side effects in patients with less stringently defined treatment resistance.

Antipsychotic Agents↗
PubMed1998

Health care expenditure on schizophrenia patients in Belgium.

Schizophrenia generates a great deal of cost and burden. The aim of this study was to assess the direct costs for schizophrenia patients receiving standard treatment in different settings in Belgium. Costs were calculated for patients and for the Belgian insurance system. Data from Belgium's largest sickness fund were used to estimate health expenditures for all schizophrenia patients in Belgium. The mean direct treatment cost was $12,050 per patient per year, or $304 million for all schizophrenia patients per year. This cost constitutes 1.9 percent of the Belgian Government's total health expenditure. Government expenditure per schizophrenia patient is 10 times that of an average citizen.

Adult↗
PubMed1998

Good medical practice in antipsychotic pharmacotherapy.

Schizophrenia requires a comprehensive treatment programme that augments pharmacotherapy, such as antipsychotic drugs, with psychological (education) and social (rehabilitation) therapies. Antipsychotic drugs, however, are still fundamental in the treatment of schizophrenia. When administered correctly, these drugs not only reduce psychotic symptoms but can also prevent relapse, which prevents hospitalization and facilitates psychosocial re-integration. Unfortunately, the type of drug and dosing schedule used are often inappropriate. The antipsychotic drug prescribed should be decided on an individual patient basis according to the experiences the patient has had with previous treatments. Choosing the right drug is a key to improving compliance and treatment outcome. Additionally, antipsychotic drugs should be prescribed at an early stage, in order to increase the likelihood of a favourable treatment outcome, and for long enough to reduce the risk of relapse. The efficacy and tolerability of antipsychotic drugs have been studied extensively, and treatment guidelines have now been developed, in particular from the Bruges Consensus Conference and the American Psychiatric Association, to optimize the diagnosis and treatment of schizophrenia. The use of novel antipsychotics, which have better therapeutic and safety profiles than traditional antipsychotics, together with educational programmes should improve compliance with antipsychotic drugs and thus improve treatment outcomes for schizophrenic patients. Treatment strategies to be used at the various stages of schizophrenia have been recommended, together with preferred options for managing lack of response or side effects.

Antipsychotic Agents↗
PubMed1997

A comparison of quetiapine and chlorpromazine in the treatment of schizophrenia.

A 6-week, double-blind, randomized, multicentre, parallel-group study was conducted to compare the efficacy of quetiapine ('Seroquel') (n=101) with that of chlorpromazine (n=100) in hospitalized patients with acute exacerbation of subchronic or chronic schizophrenia, or schizophreniform disorder. The tolerabilities of the two treatments were also compared. The mean daily doses of quetiapine and chlorpromazine at the end of the study were 407 mg and 384 mg, respectively. Both treatments were effective in the treatment of positive and negative symptoms, with a trend towards superior efficacy for quetiapine. The quetiapine group had a lower incidence of adverse events than the chlorpromazine group, and a low incidence of treatment-emergent extrapyramidal symptoms. Quetiapine was not associated with a sustained increase in serum prolactin. These clinical data support the preclinical profile of quetiapine as an atypical antipsychotic agent.

Adult↗
PubMed1996

Visualisation of loss of 5-HT2A receptors with age in healthy volunteers using [18F]altanserin and positron emission tomographic imaging.

We used [18F]altanserin and positron emission tomography (PET) to image serotonin 5-HT2A receptors in humans. The highest [18F]altanserin uptake is found in the cerebral cortex, with specific-to-nonspecific binding ratios varying from 0.53 to 1.91 in humans between 24 and 48 years of age. In all neocortical regions studied, [18F]altanserin uptake correlates negatively with age. No correlations were found between age and uptake in the cerebellum, the regional cerebral blood flow, or the time course of metabolization of [18F]altanserin. The reduction in cerebral 5-HT2A receptor binding thus directly reflects the loss of specific 5-HT2A receptors with age.

Adult↗
PubMed1996

Lujan-Fryns syndrome in the differential diagnosis of schizophrenia.

Schizophrenia is considered to be a heterogenous disorder. Different etiopathological mechanism can be attributed to a similar clinical picture as described in DSM-III-R criteria. We present a case of a young man diagnosed on different occasions as schizophrenic with mild mental retardation. Clinical examination revealed signs and symptoms most compatible with the diagnosis of Lujan-Fryns syndrome, an X-linked mental retardation syndrome with marfanoid features, frequently associated with psychotic or other psychiatric symptoms. In all patients with symptoms of schizophrenia and mental retardation Lujan-Fryns syndrome should be considered in the differential diagnosis.

Abnormalities, Multiple↗
PubMed1996

Proper psychosocial rehabilitation for stabilised patients with schizophrenia: the role of new therapies.

Schizophrenia impairs the development of social skills needed for useful, independent living. Psychotherapeutic approaches increase the value of antipsychotic drugs by helping patients cope with the social pressures to which they are particularly vulnerable. Antipsychotic drugs reduce psychosis, protect against stressors and, taken lifelong, provide considerable relapse protection. Low-dose or intermittent medication regimens reduce the incidence of side effects but give less protection against relapse than continuous full-dose therapy. For the move towards community- rather than hospital-based care to succeed, comprehensive, multidisciplinary, integrated services are essential. Individually tailored psychosocial rehabilitation enables patients to make the best use of their capabilities. In addition, family therapy increases the effectiveness of drugs and reduces relapse rates. New antipsychotic drugs are likely to be more effective than conventional neuroleptics because they offer broader spectra of activity, induce fewer side effects and are more likely to be taken as directed.

Family Therapy↗