Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Current research and practice in the treatment of schizophrenia Dr. Aaron Frost What is Schizophrenia Dementia Praecox “Split Mind” Psychotic illness (out of touch with reality) Hallucinations & Delusions (Bizarre or not) Negative Symptoms Apathy, Avolition, Alogia Disorganisation (thought disorder) Catatonia Subtypes Catatonic Disorganised Paranoid Undifferentiated Residual Facts and Figures Life time prevalence of just under 1 per hundred Yearly incidence averages out to 15:100,000 Modal age of onset Men : 18 – 25 Women : 25 – 35 (second peak after menopause) Early Onset linked with poor prognosis Cost of Schizophrenia $46,200 per patient per year $27,500 lost productivity $13,800 in patient treatment $4,900 in other community care $1.45 billion direct costs $2.25 billion societal costs. Carr et al., (2003) Averting Burden Current Optimal Unavertable Current treatment of schizophrenia can avert approximately 13% of the burden Optimal treatment could avert 22% of the burden The majority of the burden of schizophrenia cannot currently be averted Andrews et al., (2003) What Causes Schizophrenia 50% Genetic concordance (polygenic) Birth Complications Late Winter / Spring births (vitamin D) Bidirectional relationship with cannabis Stress Neurochemical Neurobiological Dopamine Hypothesis Kapur et al., (1995) Reduced Neuropil Hypothesis Normal Schizophrenia Seleman et al., (1998) Schizophrenia is degenerative Thompson et al., (2001) What works in Schizophrenia Intervention Medication Family Therapy CBT Supported Accommodation Vocational Rehabilitation Assertive Case Management Level of Evidence I I Reference I III-c Gould et al., (2001) Girolamo et al., (2005) I III-b II Twamley et al., (2003) Warner (2002) Rosen & Teesson (2002) Davis et al., (2003) Pilling et al., (2002) What doesn’t work in Schizophrenia Intervention Social Skills Training Level of Reference Evidence I Pilling et al., (2002) Cognitive remediation I Pilling et al., (2002) Case Management I Marhsall et al., (2001) All medications are created equal Neuroleptics Chlorpromazine Haloperidol (plus a dozen others) Atypical Antipsychotics Risperidone Olanzapine Quetiepine Amisulpride Aripiprazole Side effect profile varies, efficacy does not Except One Clozapine is genuinely more effective than all other agents (both statistically and clinically significant) Clozapine is also the only one with demonstrated efficacy / effectiveness on negative symptoms Clozapine occasionally causes a fatal white blood condition called agranulocytosis (1 – 2% patients) Cost of administration is very high Alvir et al (2003) Medication Compliance Medication compliance is often poor and intermittent Partly this is due to lack of insight, partly due to the severity of side effects Long acting depot medications are available for the neuroleptics, but currently only one of the atypicals. Efficacy of Treatment Hegerty et al., (1994) Why are we getting less effective ? Health Data Patient Functioning over Time 25 HoNOS 20 High 15 Middle 10 Low 5 0 intake 3mths 6mths 9mths 12mths Early Intervention Early Intervention has been proposed as an approach to the treatment of schizophrenia that has a more hopeful prognosis Pre-morbid Prodrome DUP Psychosis Prevention is difficult The best studies find around 30% transition rate Reduction in DUP is crucial Psychological Interventions Self Esteem Family Therapy Cognitive Therapy