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Biomedical subjects

Raymond C Love

Publications and source records attributed to Raymond C Love.

12 recordsLinked to original sources
PubMed2005

Comparison of clozapine use in Maryland and in Victoria, Australia.

OBJECTIVE: Studies of how differences in systems of care, including cultural differences, affect prescribing practice and patient outcomes are important and can help answer questions such as the effectiveness of clozapine in routine practice. This study examined the use of clozapine in Maryland and in Victoria, Australia. METHODS: This study used medical record data to examine the use of clozapine in January 2000 for people with schizophrenia in two different countries. Data were gathered from all six public inpatient facilities in Maryland and from the two main community outpatient centers in Victoria. Outpatients were studied in Victoria because Australia's inpatient mental health facilities have closed and people with treatment-resistant schizophrenia are managed exclusively as outpatients. RESULTS: In Maryland 591 inpatients with schizophrenia were given a prescription for second-generation antipsychotics; in Victoria 356 outpatients with schizophrenia were given such a prescription. Among second-generation antipsychotics, clozapine was used significantly more frequently in Australia than in Maryland for the treatment of schizophrenia (173 prescriptions, or 49 percent, compared with 144 prescriptions, or 19 percent). Both systems used clozapine mostly for the treatment of schizophrenia (94 percent in Victoria compared with 88 percent in Maryland). The mean clozapine dosages that were used for the treatment of schizophrenia were significantly higher in Maryland than in Australia (522 mg per day compared with 431 mg per day). CONCLUSIONS: Significant differences in use and dosages of clozapine were found in two populations that were similar in diagnoses and demographic characteristics.

Adult↗
PubMed2004

Long-acting risperidone injection.

PURPOSE: The pharmacology, pharmaceutics, clinical efficacy, adverse effects, cost, and dosage and administration of long-acting risperidone injection are reviewed. SUMMARY: Risperidone is the first atypical antipsychotic available in a long-acting injectable formulation. After a single injection, significant plasma levels of the drug are achieved at week 3 and sustained through week 6, subsiding by weeks 7-8. Steady state is achieved after four injections. Peak levels are less than those seen with comparable doses of oral risperidone. A 12-week double-blind placebo-controlled study and a one-year open-label study demonstrated the efficacy, safety, and tolerability of long-acting risperidone injection in patients with schizophrenia and schizoaffective disorder. Those who were considered stable on their previous medication showed continued clinical improvement and an increase in health-related quality of life during a year of treatment with long-acting risperidone injection. In the 12-week study, risperidone was well tolerated, with adverse-effect rates similar to those seen with placebo. Weight gain with long-acting risperidone injection is similar to that found with oral treatment. Extrapyramidal symptom ratings have shown improvement from baseline following administration of this agent. Individuals with schizophrenia who previously received oral risperidone therapy have shown a reduction in prolactin levels after a switch to the long-acting formulation. CONCLUSION: With its unique tolerability and efficacy, long-acting risperidone injection has the potential to extend the benefits of assured medication delivery and improved long-term outcomes to more patients with schizophrenia.

Antipsychotic Agents↗
PubMed2004

Atypical antipsychotic use in a state hospital inpatient adolescent population.

Atypical antipsychotics are now the most commonly prescribed antipsychotics in young patients. These drugs are increasingly being used because of better tolerance and safety as seen in the adult populations. Youth with more severe psychopathology who are treated in the inpatient setting have been overlooked in much of the published research, and the extent of use and rationale in this population is unknown. This naturalistic retrospective study examined a population of adolescents in an inpatient state hospital setting with regard to their use of atypical antipsychotics. All patients who received an inpatient prescription for atypical antipsychotics between January 1, 1997 and June 1, 2000 and were ages 18 or younger at the time of medication initiation were included in the study. Twenty-three percent (88/380) of patients received an atypical antipsychotic: 68% (60/88) risperidone, 27% (24/88) olanzapine, and 5% (4/88) quetiapine. Psychotic disorders were considered as the primary diagnosis in only 17% of patients treated with atypical antipsychotics, and no particular diagnosis was predictive of monotherapy with an atypical antipsychotic. In the adolescent populations, atypical antipsychotics are being used for a wide variety of diagnoses and are commonly used adjunctively (more than 80%) with many concomitant psychotropic medications. More research is needed to develop useful and specific practice guidelines in children and adolescents for these commonly used medications.

Adolescent↗
PubMed2003

Expert consensus-based medication-use evaluation criteria for atypical antipsychotic drugs.

Medication-use criteria for the appropriate use of atypical antipsychotics were developed through a national consensus process utilizing an expert panel. A written survey was prepared which asked for opinions about options for psychopharmacologic interventions with seven antipsychotic drugs or categories (clozapine, olanzapine, quetiapine, risperidone, ziprasidone, long-acting intramuscular decanoate ester preparations of conventional antipsychotics, and oral conventional antipsychotics) in 19 specific clinical situations. The survey was sent to 50 psychiatrists and psychiatric pharmacist specialists, 42 (84%) of whom completed the survey. The survey was formatted as a grid with rows listing various clinical situations and columns itemizing the various antipsychotic medications relevant to the situations. Responses were scored using a 9-point scale for rating the level of medical review required for any given decision. Consensus on each option was defined as a nonrandom distribution of scores by a chi-square goodness-of-fit test. Consensus was reached for 1179 of the 1230 items reviewed. Use of clozapine as a first-line therapy warranted prospective or mandated review for all diagnoses. Use of nonclozapine atypical agents for schizophrenia and schizoaffective and delusional disorders was judged to be the standard of care. Oral conventional antipsychotic agents were not considered the standard of care for any indication. Combination antipsychotic treatment always warranted at least concurrent review. Continued concerns about the use of ziprasidone and its cardiac effects were apparent. This study demonstrated the utility of a consensus-based process in addressing issues and practices not adequately addressed in the scientific literature.

Antipsychotic Agents↗
PubMed2003

Rehospitalization risk with second-generation and depot antipsychotics.

Decreasing hospital admissions is important for improving outcomes for people with schizophrenia. Second-generation antipsychotics (SGAs) are better tolerated for long-term therapy than traditional medications and may contribute to a lower rehospitalization risk, but have not been compared to depot forms with regard to long-term outcomes. This study evaluates the risk of readmission in patients discharged from six State of Maryland inpatient mental health facilities between Jan. 1, 1997 and Dec. 31, 1997 on clozapine (N = 41), risperidone (N = 149), and olanzapine (N = 103). These patients were compared with those discharged from the two largest state facilities during the same time period on fluphenazine decanoate (N = 59) or haloperidol decanoate (N = 59). One-year readmission risk (measured by Kaplan-Meier survival analysis with Holm's adjustment for multiple comparison on Log Rank tests) were 10% for clozapine, 12% for risperidone, and 13% for olanzapine. These risks were not significantly lower than the readmission risk for fluphenazine decanoate (21%) but were significantly lower than haloperidol decanoate (35%) for all three SGAs. Demographic and clinical variables did not predict readmission for any of the medications. In patients with similar demographic and clinical characteristics, 1-year risk of readmission for patients treated with SGAs were at least comparable to the 1-year risk for patients receiving fluphenazine decanoate and lower than the risk for patients treated with haloperidol decanoate. SGAs may provide better long-term prognoses and outcomes for patients with schizophrenia.

Adult↗
PubMed2003

A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities.

This article presents recommendations developed in 2001 by a committee of the Maryland Department of Health and Mental Hygiene that are used for managing acute aggressive behavior of youths in residential and inpatient treatment facilities in Maryland. The recommendations are highly similar to practice parameters published by the American Academy of Child and Adolescent Psychiatry, although they were developed independently. The recommendations are not prescriptive, nor are they based on an algorithm. Rather, they are based on a therapeutic process and designed to acknowledge the importance of professional and patient autonomy. The first step in the therapeutic process is to define the problem by addressing three issues: the target symptoms, the severity of those symptoms, and possible precipitants of the aggressive behavior. The next two steps are to select the goals of the intervention and to choose among three levels of immediate intervention, from least to most restrictive. The recommendations describe specific interventions, including medications that can be used at each level. The authors caution that the recommendations should be used in accordance with current regulations of the Center for Medicaid and Medicare Services and the Joint Commission on Accreditation of Healthcare Organizations.

Adolescent↗
PubMed2002

Strategies for increasing treatment compliance: the role of long-acting antipsychotics.

Increased patient compliance with antipsychotic medications is associated with increased efficacy and reduced rates of rehospitalization. It can improve treatment outcomes for patients and reduce costs for society. An understanding of the reasons for noncompliance is essential in formulating strategies to provide better health and economic outcomes. Time-tested strategies such as addressing adverse effects, educating patients, and forming patient-provider alliances with those receiving medications can have a dramatic impact on compliance. Depot antipsychotics have been the mainstay of treatment for patients with schizophrenia who are known to be noncompliant. These agents are especially effective when combined with social support. Atypical antipsychotics, with their improved efficacy and tolerability, appear to increase compliance and reduce rehospitalization compared with conventional oral and depot agents. A new long-acting formulation of an atypical antipsychotic agent combines the advantages of depot drugs and atypical agents. However, such a drug also poses challenges in the changing setting of community mental health. These challenges present pharmacists with an opportunity to assume new roles in the management of patients requiring antipsychotic therapy.

Antipsychotic Agents↗
PubMed2002

Novel factor-based symptom scores in treatment resistant schizophrenia: implications for clinical trials.

To study the factor structure of symptoms in patients with treatment resistant schizophrenia and whether it is altered by treatment, we analyzed ratings on the Brief Psychiatric Rating Scale (BPRS) from two independent groups of patients with treatment resistant schizophrenia. With confirmatory factor analysis of pre-clozapine BPRS scores in 1074 patients in an administrative data base, the Clozapine Authorization and Monitoring Program (CAMP), we assessed the fit of published factor models and developed a better-fitting model. Model fit was validated in an independent group of 197 research unit participants. Stability of model fit six months post-clozapine was assessed in 834 CAMP patients. A new 4-factor model (negative symptoms, reality distortion, disorganization, and anxiety/depression) had better fit in both data sets than two commonly used factor models, and also fit better post-clozapine. We recommend these four factor scores as clinical trial outcomes in patients with treatment resistant schizophrenia.

Adolescent↗
PubMedDate not supplied

Risperidone, quetiapine, and fluphenazine in the treatment of patients with therapy-refractory schizophrenia.

This 12-week, double-blind study evaluated the effectiveness of risperidone (4 mg/day), quetiapine (400 mg/day), or fluphenazine (12.5 mg/day) in a stringently defined treatment-resistant population of people with schizophrenia. No differences were noted in total Brief Psychiatric Rating Scale (BPRS) or Clinical Global Impression scores among the drug groups (n = 38). More subjects tended to complete the study on risperidone (69%) or quetiapine (58%) than those treated with fluphenazine (31%; P value not significant). Eighty-nine percent of those who discontinued on fluphenazine (8 of 9) were due to lack of efficacy. Discontinuation due to adverse effects was low, with only 2 subjects (both on quetiapine) stopping due to side effects. Three of 13 risperidone-treated subjects (23%) and 3 of 12 quetiapine-treated subjects (25%) met response criteria (decrease of 20% of total BPRS score), whereas 2 of 13 subjects (15%) responded to fluphenazine. Side effect occurrence was similar among drug groups and EPS ratings on the Simpson Angus Scale improved in all drug groups (quetiapine, 1.64; risperidone, 1.30; fluphenazine, 0.69; P value not significant). Despite the newer class of second-generation antipsychotic medications, this treatment-resistant population remains difficult to treat. Many people have only minimal to modest improvements with antipsychotic treatment and most continue to have residual psychotic symptoms. Treatment with first- and second-generation antipsychotics may demonstrate similar efficacy; however, patients treated with second-generation antipsychotics may be more likely to adhere to treatment.

Adolescent↗