07 Июль, 2003
Fresh thinking in battle against schizophrenia
A CAMPAIGN launched in Bristol yesterday sets out to provide better help for thousands of schizophrenics. Western Daily Press via NewsEdge Corporation : A CAMPAIGN launched in Bristol yesterday sets out to provide better help for thousands of schizophrenics. It comes after an inquiry this week heard how Bristol paranoid schizophrenic Matthew Martin battered his father to death with an axe after being neglected by the authorities. About 60,000 people in the South West suffer from the condition which includes hallucinations, delusions and behavioural problems among its symptoms. Yet fewer than 20 per cent of patients have access to the best new treatments. The 1 in 100 initiative aims to tell sufferers and their carers about the medication and support they can get. Martin, who is now in a secure unit, slipped through the net after a catalogue of "missed opportunities" by mental health workers, prisons and social services, the report concluded. Although such tragedies are unusual, the 1 in 100 campaign aims to make people aware of the improvements in treatments and encourage better communication between patients, their families and the medical profession. The National Institute for Clinical Excellence (Nice), which decides what should be available on the NHS, is recommending that newly-diagnosed sufferers and those experiencing side effects from older antipsychotics should be offered new antipsychotic drugs. Paddy Cooney, director of Mental Health South West, which is supporting the campaign, said: "In light of the Nice guidelines for schizophrenia, we want everyone to be aware of what treatments are on offer, including both medications and psychological treatments, how they work, and how to get them." The newer type of medication, available in tablets, liquids and injections, targets a broader range of symptoms than before. David Dixon, 62, from near Wedmore, Somerset, suffered from manic depression for 10 years. "I started to lose touch with reality, couldn't make decisions and suffered hallucinations and voices in my head. Manic depression is quite similar to schizophrenia," he said. Yet after leaving his job as an engineer to take up writing and through the love and support of his family, Mr Dixon reclaimed his life. Now on the board of Mental Health South West, he said: "Statistics show that 25 per cent of schizophrenics can recover fully and 40 per cent can manage very well on the drugs. With drugs to get out of the cavity many more people can climb the mountain." Publication: Western Daily Press Distributed by Financial Times Information Limited <> << Copyright ©2003 Financial Times Limited, All Rights Reserved >>
05 Июль, 2003
Antipsychotic withdrawal symptoms "do not affect clozapine response"
LONDON Newswire reporters Symptom exacerbation following withdrawal of typical antipsychotics does not appear to reduce the subsequent response to clozapine in treatment-resistant schizophrenic patients, say US researchers. HMG - Health Newswire Professional via NewsEdge Corporation : LONDON By Health Newswire reporters Symptom exacerbation following withdrawal of typical antipsychotics does not appear to reduce the subsequent response to clozapine in treatment-resistant schizophrenic patients, say US researchers. There has been considerable debate about whether stopping antipsychotic medication affects long-term outcome in patients with schizophrenia. Some researchers have suggested that discontinuation of antipsychotics might be harmful. This has raised the question of whether the use of placebo washouts in clinical trials of patients with schizophrenia adversely affects the benefits of subsequent medication. To address this, Drs David Pickar and John Bartko from Gabriel Pharma in Cabin John, Maryland, examined the behavioural effects of drug washout and subsequent treatment with clozapine in 50 inpatients with treatment-resistant schizophrenia. Baseline treatment with a typical antipsychotic was given for an average of six weeks, before patients began a placebo washout period, which lasted at least four weeks. After the placebo washout, clozapine was initiated at 50 mg/day and increased gradually over 2 to 3 weeks. On average, optimal treatment with clozapine was observed after about 12 weeks, using a mean dose of 450.5mg/day. Psychiatrists, who were blind to the patients medication status, used the Brief Psychiatric Rating Scale (BPRS) to measure the severity of symptoms every week. They assessed the impact of treatment by calculating the effect sizes for the BPRS total score. An effect size of 0.2 was considered small, 0.5 was medium and 0.8 was large. The researchers found that symptoms significantly worsened during the placebo washout. When patients were switched to clozapine, symptom scores were significantly better compared to baseline treatment and the placebo washout period. The effect sizes were 0.63 for baseline treatment versus placebo washout, 1.1 for optimal clozapine treatment versus placebo washout, and 0.82 for optimal clozapine treatment versus baseline treatment. The results, say the researchers, show that, although there is clinical deterioration after the discontinuation of a typical antipsychotic, this deterioration does not appear to detract from the subsequent response to clozapine. The study also confirms the value of clozapine in treatment-resistant schizophrenia, says the team. The enhanced therapeutic effectiveness of clozapine in seriously ill patients with schizophrenia was again demonstrated in this study, said Dr Pickar. Reference: Pickar and Bartko, American Journal of Psychiatry 2003;160:1133-1138 HMG Worldwide 2003 http://www.health-news.co.uk/ Publication: HMG - Health Newswire Professional Distributed by Financial Times Information Limited <> << Copyright ©2003 Financial Times Limited, All Rights Reserved >>
05 Июль, 2003
Neurological abnormalities help in diagnosis of idiopathic psychoses
LONDON Bennett Neurological examination abnormalities may help to distinguish between patients with different idiopathic psychoses, say US researchers. HMG - Health Newswire Professional via NewsEdge Corporation : LONDON By Claire Bennett Neurological examination abnormalities may help to distinguish between patients with different idiopathic psychoses, say US researchers.Previous studies had shown that patients with schizophrenia had higher scores on measures of neurological abnormalities compared to normal subjects. However, these results were limited by possible confounding factors, including prior use of neuroleptic medications and the chronic nature of the illness. These confounding factors could have been addressed by studying first-episode, never-treated schizophrenia patients. As a result, Dr Matcheri Keshavan, from the University of Pittsburgh School of Medicine, and colleagues examined the relationship between neurological examination abnormalities and alteration in brain structure in first-episode schizophrenia patients, those with non-schizophrenic psychoses and healthy comparison subjects. The three groups were compared on motor and cognitive neurological examination abnormalities using subscales of the Neurological Evaluation Scale. Alteration in brain structure was assessed using magnetic resonance imaging in a subset of patients. The researchers found that repetitive motor task performance was impaired in schizophrenia patients and in those with non-schizophrenic psychoses. These tasks do not, however, distinguish between the two patient groups. In contrast, cognitively demanding and perceptual tasks were markedly more impaired in schizophrenic patients than in patients with non-schizophrenic psychoses and healthy controls. Dr Keshavan says, Neurological examination abnormalities may have some measure of diagnostic specificity among the idiopathic psychoses. This observation is of clinical relevance and may help clarify the pathophysiological basis of schizophrenia, as contrasted with other psychoses. The team concludes that the findings provide neurobiological validation of abnormal findings on the neurological examination. And the researchers add that these abnormalities may reflect discrete neuroanatomical alterations in schizophrenia and may have a localising value. Reference: Keshavan et al, American Journal of Psychiatry 2003;160:1298-1304 HMG Worldwide 2003 http://www.health-news.co.uk/ Publication: HMG - Health Newswire Professional Distributed by Financial Times Information Limited <> << Copyright ©2003 Financial Times Limited, All Rights Reserved >>
03 Июль, 2003
Психиатрические эскизы из истории, Том I - П. И. Ковалевский
03 Июль, 2003
New study supports efficacy of schizophrenia treatment - Schizophrenia
In a study published by the American Journal of Psychiatry, data show that people with schizophrenia who were treated with Risperdal ConstaTM, a long-acting formulation in development of the most widely prescribed antipsychotic, risperidone, experienced significant symptom relief, with relatively low levels of side effects. Drug Week via NewsEdge Corporation : In a study published by the American Journal of Psychiatry, data show that people with schizophrenia who were treated with Risperdal ConstaTM, a long-acting formulation in development of the most widely prescribed antipsychotic, risperidone, experienced significant symptom relief, with relatively low levels of side effects. Risperdal Consta is currently approved in more than 20 countries. In the U.S., discussions are ongoing with the U.S. Food and Drug Administration, which issued a non-approvable letter based on questions related to certain aspects of the pre-clinical data. Johnson & Johnson Pharmaceutical Research & Development (J & JPRD) recently filed a response to the letter to support approval. "Most experts believe that newer-generation, 'atypical' antipsychotics are the most effective and safest option for treating the symptoms of schizophrenia. Unfortunately, however, it is often difficult for patients with this disorder to take their medication consistently, on a daily basis. And when treatment is discontinued, the risk of relapse increases almost fivefold," said John Kane, MD, professor of psychiatry, neurology and neuroscience at the Albert Einstein College of Medicine in New York. "With Risperdal Consta, we expect that patients will get the benefits of a modern-class medication, in a form that only needs to be administered every two weeks." In the 12-week, double-blind study, 400 patients with schizophrenia were randomized to receive injections of placebo or Risperdal Consta (25mg, 50mg or 75mg) once every two weeks. Significant improvement was seen at all doses studied in both positive symptoms (psychological disturbances "added" as a result of the disorder, such as hallucinations, delusions, suspiciousness and paranoia) and negative symptoms (normal functioning the patient has "lost," resulting in lack of initiative, social withdrawal, lack of expression and emotional withdrawal). An average of 45% of patients, depending on the dosage administered, saw a 20 percent or greater degree of symptom improvement. All doses of Risperdal Consta were well tolerated. The number of patients who dropped out of the study due to side effects was similar between the three groups receiving long-acting risperidone and those who took placebo (12% of the placebo group compared to 11, 12 and 14% of patients receiving a 25mg, 50mg or 75mg dose of risperidone once every two weeks, respectively). The most common side effects reported were headache, upset stomach, restlessness, drowsiness, constipation, fatigue and dry mouth. Rates of extrapyramidal symptoms (EPS), a concern with all antipsychotic medications, were similar between the groups receiving placebo (13%) and 25mg of Risperdal Consta (10%), the expected starting dose. At higher doses, EPS (such as slowness of movement, muscle spasms, or restlessness) rates were slightly higher among patients receiving the higher doses of Risperdal Consta compared to the placebo group (24% at 50mg and 29% at 75mg). Weight gain, another side effect of some antipsychotics, was minimal among patients receiving Risperdal Consta, ranging from 1.1 pound over the course of 12 weeks among those administered 25mg, to 2.6 pounds among the 50mg group and 4.2 pounds for patients taking 75mg. Patients enrolled in the study were given oral risperidone for one week at the start of the study. Oral treatment continued for another three weeks after the injections began to provide a smooth transition between the oral and injectable formulations. This article was prepared by Drug Week editors from staff and other reports. <> << Copyright ©2003 NewsRx.com >>
03 Июль, 2003
Cannabis link to psychosis
Very heavy use of cannabis could be a cause of psychosis, according to a leading psychiatrist who believes that society should think carefully about the potential consequences of its increasing use. The Guardian via NewsEdge Corporation : Very heavy use of cannabis could be a cause of psychosis, according to a leading psychiatrist who believes that society should think carefully about the potential consequences of its increasing use. Robin Murray, professor of psychiatry at the Institute of Psychiatry and consultant psychiatrist at the Maudsley hospital in London, says that in the last 18 months, there has been increasing evidence that cannabis causes serious mental illness. In particular, a Dutch study of 4,000 people from the general population found that those taking large amounts of cannabis were almost seven times more likely to have psychotic symptoms three years later. "This research must not be ignored," said Professor Murray, speaking at the annual general meeting of the Royal College of Psychiatrists in Edinburgh. Writing in the Guardian last August, Professor Murray said he had been surprised that the discussion around cannabis had skirted around the issue of psychosis. Psychiatrists had known for 150 years that very heavy consumption of cannabis could cause hallucinations and delusions. "This was thought to be very rare and transient until the 1980s when, as cannabis consumption rose across Europe and the USA, it became apparent that people with chronic psychotic illnesses were more likely to be regular daily consumers of cannabis than the general population." In the UK, he said, people with schizophrenia are about twice as likely to smoke cannabis. The reason appears to be the effect that the drugs have on chemicals in the brain. "In schizophrenia, the hallucinations and delusions result from an excess of a brain chemical called dopamine. All the drugs which are known to cause psychosis - amphetamine, cocaine and cannabis -increase the release of dopamine in the brain." Cannabis had been the downfall of many a promising student, he suggested. "Like any practising psychiatrist, I have often listened to the distraught parents of a young man diagnosed with schizophrenia tell me that as a child their son was very bright and had no obvious psychological problems. Then in his mid-teens his grades began falling. He started complaining that his friends were against him and that people were talking about him behind his back. "After several years of increasingly bizarre behaviour, he dropped out of school, job or university; he was admitted to a psychiatric unit overwhelmed by paranoid fears and persecution by voices. The parents tell me that, at some point their son was heavily dependent on cannabis." It used to be thought that the high numbers of psychotic patients taking cannabis could be explained because they used it to alleviate their symptoms. The recent studies, however, have looked at large populations without mental illness and studied the numbers of cannabis takers within them who have developed psychosis. Publication: The Guardian Distributed by Financial Times Information Limited <> << Copyright ©2003 Financial Times Limited, All Rights Reserved >>
30 Июнь, 2003
Избранные труды В.М. Бехтерева; Труды клиники на девичьем поле - П.Б. Ганнушкин.

Избранные труды В.М. Бехтерева;

Труды клиники на девичьем поле - П.Б. Ганнушкин.

23 Июнь, 2003
Новый раздел

Появился новый раздел "В центре внимания". Первый выпуск посвящен атипичным нейролептикам и содержит более 50-ти полных текстов статей об исследованиях этих препаратов

19 Июнь, 2003
Конференция WPA 19-22 июня 2003

Дорогие коллеги, Мы хотели бы особо обратить Ваше внимание на конференцию, которую намеревается провести WPA в Вене (19-22 июня 2003 г.).

Тема этой научной встречи представлена психиатрическому сообществу в выпуске «Nosology and Classification». Предполагается, что предметом научного обсуждения станет ряд комментариев к международной классификации болезней, касающихся, в частности, временной диагностической нестабильности для многих расстройств и состояний, злоупотребления понятием коморбидность при постановке психиатрического диагноза, что подрывает гипотезу о четком соответствии синдромов определенной этиологии.

Дальнейшая утрата специфичности терапии является скорее правилом чем исключением. Грубое и часто некорректное, не учитывающее национальных особенностей, внедрение критериев МКБ-10 и DSM-IV подрывает исследования этиологии психических расстройств. Конкретное использование рубрик МКБ в качестве диагнозов заболеваний, скорее скрывает истину, чем объясняет исследовательские данные.

Организаторы этой встречи хотели бы поощрить исследовательскую программу конференции, выходящую за пределы заполонивших все дименсиональных подходов. «Нам необходима классификация, в которой была бы интегрирована информация, полученная из всего разнообразия источников и технологий».

Тема этой встречи будет направляющей для дальнейшего развития психиатрической нозологии. Организаторы уверены в успехе этого научного сотрудничества, с привлечением ученых высокого калибра и организационных возможностей WPA.

Крайний срок подачи постеров - 25 февраля 2003 г.

Всю дополнительныю информацию Вы можете найти на домашней странице конференции: www.wpa2003vienna.at

Организаторы конференции:

Профессор, Президент WPA Axmed Okasha
Профессор психиатрии Женевского Университета,
Председатель научного комитета Norman Sartorius
Профессор Венского университета Heinz Katschig

18 Июнь, 2003
Пополнение в разделе Исследователям

в разделе для исследователей размещены шкалы PANSS, UKU, ESRS.