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Biomedical subjects

J Peuskens

Publications and source records attributed to J Peuskens.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1996

Partial hospitalization at night: the Brussels Nighthospital.

This paper describes the Brussels Nighthospital, which has offered partial hospitalization to young chronic psychiatric patients since 1978. The hospital's rehabilitation program provides evening treatment and nighttime accommodations to approximately 44 individuals, who live in the facility for about a year. During the day patients are engaged in useful activities outside the facility. The night hospital has developed a network of such placements. Psychotherapy and family support groups are also offered. A follow-up study of 120 patients (mean time after discharge = 4.2 years) showed that most maintained their achieved level of adaptation and continued to live in the community engaged in useful activities.

Belgium↗
PubMed1995

Risperidone in the treatment of negative symptoms of schizophrenia: a meta-analysis.

Risperidone has antiserotonergic and antidopaminergic properties that may make it more effective than conventional antipsychotic agents in the treatment of the negative symptoms of schizophrenia. Clinical trials in chronic schizophrenic patients have shown trends in favor of risperidone in the control of negative symptoms compared with haloperidol, perphenazine or zuclopenthixol, but the differences were not consistently statistically significant. A meta-analysis of the pooled results from six double-blind trials showed that risperidone at doses ranging from 4 to 8 mg/day had a significantly (p < 0.004) higher negative symptom response rate, defined as the percentage of patients with a 20% or more reduction in scores on the negative subscale of the Positive and Negative Syndrome Scale, than patients receiving active controls. The combined patient population treated with 4-8 mg/day of risperidone was 1.43 times more likely to have had a clinical response on the negative symptom subscale than the combined population treated with haloperidol, perphenazine or zuclopenthixol.

Double-Blind Method↗
PubMed1995

Risperidone in the treatment of patients with chronic schizophrenia: a multi-national, multi-centre, double-blind, parallel-group study versus haloperidol. Risperidone Study Group.

BACKGROUND: This study was performed in order to evaluate the short-term efficacy and safety of fixed risperidone doses compared to haloperidol. METHOD: In a multi-national, parallel-group, double-blind study, patients with chronic schizophrenia (DSM-III-R) were randomly assigned to risperidone 1, 4, 8, 12 or 16 mg or haloperidol 10 mg daily for 8 weeks. Efficacy was assessed by the Positive and Negative Syndrome Scale for schizophrenia (PANSS) and clinical global impression (CGI), and safety primarily by the Extrapyramidal Symptom Rating Scale (ESRS). RESULTS: One thousand three hundred and sixty-two patients were evaluated. The optimum risperidone doses were 4 mg and 8 mg, with response rates of 63.4% (56.8%; 69.7%) and 65.8% (59.2%; 71.9%) respectively. Response rate in haloperidol-treated patients was 58.7% (52.0%; 65.3%); the 95% confidence intervals (CI) of the differences between risperidone 4 mg or 8 mg and haloperidol were (- 4.3%; 13.7%) and (- 1.9%; 16.0%) respectively. There were no significant differences in CGI scores at endpoint between risperidone 4 mg, 8 mg, 12 mg and 16 mg and haloperidol (3.0, 3.0, 3.2, 3.1 and 3.1 respectively); the 95% CI of the differences between risperidone 4 mg or 8 mg and haloperidol were ( - 0.4; 0.1) and ( - 0.3; 0.2) respectively. Mean shifts to the maximum total ESRS scores versus baseline (mean (confidence interval)) were significantly greater in haloperidol-treated patients (5.1 (4.0; 6.2)) than in the risperidone 1, 4, 8 and 12 mg groups (1.1 (0.3; 1.9); 1.8 (0.9; 2.7); 2.7 (1.8; 3.6) and 3.2 (2.3; 4.1) respectively (P < 0.05)). CONCLUSION: Risperidone is an effective antipsychotic for the treatment of chronic schizophrenia; doses of 4 and 8 mg seem to be optimal and have a lower incidence of side-effects than haloperidol.

Adult↗
PubMed1994

Study of the possible association of HLA class II, CD4, and CD3 polymorphisms with schizophrenia.

In the present study the HLA-DRB and DPB1 alleles as well as CD4 and CD3 polymorphisms were tested in 100 Belgian schizophrenic patients and 204 controls. Our results indicate a significant negative association of the DPB1 0101 allele with schizophrenia (relative risk [RR] = 0.27). Furthermore a significant positive and negative association could be noticed for the CD4*A4 allele and CD4*A7/A8 genotype, respectively (RR 1.79 and 0.47, respectively). These findings suggest that some contribution of HLA class II and CD4 genes to an autoimmune-like pathogenesis in schizophrenia might exist.

Adolescent↗