A flawed study design?
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Behavior Therapy↗
Biomedical subjects
R I Hector
Publications and source records attributed to R I Hector.
The use of clozapine in the treatment of aggressive schizophrenia.
The atypical antipsychotic drug clozapine was introduced to clinical practice in 1972. It is a dibenzodiazepine derivative with, among other known receptor site activities, a relatively high D1/D2 receptor affinity ratio. The serious side effects of bone marrow suppression and agranulocytosis delayed the acceptance of clozapine into common clinical practice but scrupulous application of a monitoring protocol led to adequate protection from these side effects. There is now a broad consensus about the benefits of clozapine which supports the use of clozapine as a first-line treatment of schizophrenia. There is good evidence that relapse and rehospitalization drop to 22% of the incidence in preclozapine treatment patients. The majority of responders are identified within 4 months of treatment. Clozapine has been demonstrated to be an effective treatment for neuroleptic refractory patients. Forty percent of clozapine-treated patients show significant improvement, with 11% of treated patients showing no residual psychosis. This review also describes the results of clozapine on aggressive and violent assault in a patient population characterized by severe functional deficits, typically chronic schizophrenia with severe impairment, chronic brain syndromes, and developmental handicap. Prior to the introduction of clozapine therapy, in a chronically disrupted milieu that precluded adequate psychosocial programming, seriously assaultive behaviour resulting in peer and staff injury was a common occurrence. Evidence suggests that clozapine is an effective medical treatment for the target symptoms of hostile agitation, threatening, and assaultive violence.
Administration, Oral↗
An overview of the Canadian health care experience.
Canada's universal health insurance system is designed to assure all Canadians access to free hospital and medical treatment. Each province has had considerable latitude in administering the system within its borders. To cope with rising costs, most provinces have adopted policies that limit physician income. Others have instituted fees for service users and have allowed physicians to bill patients for charges above the benefit schedule set by the province. These latter practices have been seen as eroding access to health care, and government funding for provinces that permit them was sharply curtailed by the Canada Health Act of 1984. The law is currently being challenged by the Canadian Medical Association because of the restrictions it places on physicians' freedom of practice. Although the Canadian system has created problems for physicians, the authors believe it provides a benefit no one wants to lose: accessible medical care for all.
Canada↗