[Adta] Fw: NEW DETAILS IN SCHIZOPHRENIA TREATMENT TRIAL EMERGE

[Barbara A Busse]

Hello,
This came to me and i thought I would pass it along.  What does it mean to
us?  What do we have special to contribute
to the rehabilitation process?

I include here a quote from below:

"Overall, the findings reiterate the widely held belief that antipsychotic
medications alone are not sufficient in helping patients make meaningful
gains in real-world functioning," said Dr. Swartz. "Dedicated
rehabilitative services that help patients learn to function at work and in
social settings are sorely needed."

Take care!  Barbara Busse




----- Forwarded by Barbara A Busse/MCLibrary/mc/Duke on 03/02/2007 03:41 PM
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             H.GOV>                    NEW DETAILS IN SCHIZOPHRENIA        
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             03/01/2007 08:44                                              
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U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH
NIH News
National Institute of Mental Health (NIMH)
<http://www.nimh.nih.gov/>

EMBARGOED FOR RELEASE: Thursday, March 1, 2007, 12:01 a.m. ET

CONTACT: Colleen Labbe or Mary Partlow, NIMH Press Office, 301-443-4536,
<e-mail: NIMHpress at nih.gov>

NEW DETAILS IN SCHIZOPHRENIA TREATMENT TRIAL EMERGE

Two new studies from the Clinical Antipsychotic Trials for Intervention
Effectiveness (CATIE) provide more insights into comparing treatment
options, and to what extent antipsychotic medications help people with
schizophrenia learn social, interpersonal and community living skills. The
new studies are published in the March 2007 issue of the "American Journal
of Psychiatry". CATIE, a $42.6 million, multi-site study, was funded by the
National Institutes of Health's National Institute of Mental Health (NIMH).

COMPARING NEWER ANTIPSYCHOTIC MEDICATIONS AFTER OLDER ONE FAILS
Quetiapine, and to some extent olanzapine, may be more effective than
risperidone among patients who were originally taking, but had to
discontinue, perphenazine -- an older, first generation antipsychotic
medication. However, patient responses varied considerably.

"CATIE continues to fine-tune our understanding of how our arsenal of
antipsychotic medications work in real-world settings, but it also is
revealing to us what questions we still must address," said NIMH Director
Thomas R. Insel, M.D.

Of the 257 patients who were initially randomized to perphenazine in the
CATIE study, 192 discontinued the medication for various reasons, including
ineffectiveness and intolerable side effects. Among those who discontinued,
114 agreed to be re-randomized to one of three newer antipsychotic
medications -- olanzapine, quetiapine or risperidone.

T. Scott Stroup, M.D., MPH, of the University of North Carolina at Chapel
Hill, and colleagues compared the effectiveness of the medications by
determining how long patients stayed on their assigned medication. Those
taking quetiapine stayed on the longest -- averaging about ten months
before discontinuing. Those taking olanzapine discontinued after an average
of about seven months, and those taking risperidone discontinued after an
average of four months.

Although the discontinuation results suggest that olanzapine was generally
on par with quetiapine, patients taking olanzapine experienced more side
effects. While none of those taking quetiapine discontinued use due to
weight gain or metabolic side effects, 13 percent of those assigned to
olanzapine discontinued it due to weight gain or metabolic problems, and 5
percent of those on risperidone did so.

"These results reinforce the fact that finding the most effective
medication for each patient sometimes means trying multiple medications,"
said Dr. Stroup. "They remind us of the considerable variability in
clinical circumstances and of our need to be responsive to an individual's
needs and preferences."

SCHIZOPHRENIA PATIENTS' SOCIAL AND COMMUNITY LIVING SKILLS IMPROVE MODESTLY
WHILE ON ANTIPSYCHOTIC MEDICATIONS
Patients with schizophrenia taking antipsychotic medications experience
modest improvements in social, interpersonal and community living
(psychosocial) skills, regardless of what antipsychotic medication they are
taking.

Improvements in psychosocial skills among patients with schizophrenia have
been notoriously difficult to achieve, even when the more disruptive
symptoms of the disease can be controlled. "Helping patients with
schizophrenia restore their psychosocial functioning remains a challenge,"
said NIMH Director Thomas R. Insel, M.D. "These CATIE results reinforce the
growing understanding that we must do a better job of helping patients get
their life skills back on track."

Marvin Swartz, M.D., of Duke University and colleagues evaluated the social
and vocational functioning, interpersonal relationships, and psychological
well-being of 455 participants -- about one-third of all patients in the
CATIE study -- who completed an initial evaluation before the study began
and were available to provide data after 12 months of treatment. In the
first phase of the CATIE study, patients were randomly assigned to take
either perphenazine -- an older, first-generation antipsychotic medication
-- or one of several newer, second-generation medications (olanzapine,
quetiapine, risperidone, or ziprasidone).

The researchers found that those patients who stuck with their initial
treatment showed some improvement in their psychosocial functioning, and
there were no differences among the medications in making these gains.  The
results are consistent with previously reported CATIE results <
http://www.nimh.nih.gov/healthinformation/catie.cfm> in which few
differences were seen among perphenazine and the newer, second-generation
antipsychotic medications in effectively reducing symptoms.

The patients who made the greatest gains were the ones with the poorest
community living skills at the beginning of the study, but they were also
more likely to discontinue treatment early in the process. As noted in
previous CATIE reports, many patients discontinued their initial treatments
because of intolerable side effects or ineffectiveness.

"Over the long run patients are more likely to function better in the
community if they are able to stay on their initial treatment, especially
those who are the most impaired," said Dr. Swartz. "More intensive
rehabilitative interventions and outreach may help patients stick with
their treatment and make greater gains."

Patients who made few gains in community living skills were those with
higher-level psychosocial skills at the beginning of the study. Swartz and
colleagues posit that patients encountered a "ceiling effect" at which
point additional psychosocial skill improvement was unlikely without
additional rehabilitative treatment.

"Overall, the findings reiterate the widely held belief that antipsychotic
medications alone are not sufficient in helping patients make meaningful
gains in real-world functioning," said Dr. Swartz. "Dedicated
rehabilitative services that help patients learn to function at work and in
social settings are sorely needed."

The National Institute of Mental Health (NIMH) mission is to reduce the
burden of mental and behavioral disorders through research on mind, brain,
and behavior. More information is available at the NIMH website, <
http://www.nimh.nih.gov>.

The National Institutes of Health (NIH) -- The Nation's Medical Research
Agency -- includes 27 Institutes and Centers and is a component of the U.
S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical, and translational
medical research, and it investigates the causes, treatments, and cures for
both common and rare diseases. For more information about NIH and its
programs, visit http://www.nih.gov.

###

-------------------------------
Stroup TS, et al. Effectiveness of Olanzapine, Quetiapine and Risperidone
in Patients with Chronic Schizophrenia After Discontinuing Perphenazine: A
CATIE Study. "American Journal of Psychiatry" 2007; 164:3.

Swartz MS, et al. Effects of Antipsychotic Medications on Psychosocial
Functioning in Patients with Chronic Schizophrenia: Findings From the NIMH
CATIE Study. "American Journal of Psychiatry" 2007; 164:3.
-------------------------------

This NIH News Release is available online at:
<http://www.nih.gov/news/pr/mar2007/nimh-01.htm>.

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