Preliminary Comparison of Predictive and Empiric Lithium Dosing: Impact on Patient Outcome

1994 ◽  
Vol 28 (10) ◽  
pp. 1148-1152 ◽  
Author(s):  
Patricia A. Marken ◽  
Kay E. McCrary ◽  
Sylvia Lacombe ◽  
Roger W. Sommi ◽  
Robijn K. Hornstra ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Length Of Stay ◽  
Rating Scale ◽  
Lithium Concentration ◽  
Statistical Significance ◽  
Cost Savings ◽  
Study Endpoint ◽  
Systematic Assessment ◽  
The Difference ◽  
Psychiatric Rating Scale

OBJECTIVE: To evaluate whether initiating lithium with predictive dosing compared with empiric dosing improves outcome in patients with manic symptoms. DESIGN: The study was a randomized, single-blind design and used the Modified Slattery predictive method. SETTING AND PARTICIPANTS: Eighteen inpatients at an urban psychiatric hospital with a Mania Rating Scale (MRS) score greater than or equal to 24 were enrolled. OUTCOME MEASURES: The study endpoint was defined as an MRS rating less than or equal to 14 or discharge from the hospital. Assessments (MRS, Brief Psychiatric Rating Scale, Clinical Global Impression, Systematic Assessment for Treatment of Emergent Events Scale, quality of life measures) were completed at baseline, on days 3 or 4 and 7 or 8, and weekly thereafter. RESULTS: The predictive group achieved a therapeutic concentration significantly sooner than did the empiric group (p=0.004); however, the mean serum lithium concentration at discharge did not differ between the groups. The predictive group was taking significantly higher dosages of antipsychotics in chlorpromazine equivalents on day 3 or 4 (p=0.05). Significantly fewer gastrointestinal/genitourinary adverse effects on day 3 or 4 were reported by patients in the predictive group (p=0.04). No difference was found between groups with any rating scale or other pharmacokinetic or medication item. Even though the difference did not meet statistical significance, the predictive group's length of stay in the acute unit was three days shorter than that of the empiric group, which may represent significant cost savings. CONCLUSIONS: The preliminary data do not suggest that patient outcome is improved by using Modified Slattery predictive dosing; however, the suggestion of a shorter length of stay in a restrictive unit merits further evaluation.

scholarly journals Review of the efficacy of placebo in comparative clinical trials between typical and atypical antipsychotics

2009 ◽  
Vol 31 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Irismar Reis de Oliveira ◽  
Paulo Menezes Nunes ◽  
Domingos Macedo Coutinho ◽  
Eduardo Pondé de Sena
Keyword(s):  
Clinical Trials ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Rating Scale ◽  
Study Drug ◽  
Typical Antipsychotic ◽  
The Difference ◽  
Psychiatric Rating Scale ◽  
Efficacy Parameters ◽  
Typical Antipsychotics

OBJECTIVE: To review the efficacy of placebo in comparison with atypical and typical antipsychotics for the treatment of schizophrenia and schizoaffective disorder and to evaluate the pertinence of using placebo in clinical trials with antipsychotics. METHOD: Trials in which the atypical antipsychotics were compared with typical antipsychotics and placebo were included. A search was conducted using the terms "amisulpride", "aripiprazole", "clozapine", "olanzapine", "quetiapine", "risperidone", "sertindole", "ziprasidone" and "zotepine". Main efficacy parameters were calculated using the proportion of "events" (defined as a deterioration or lack of improvement by at least 20% in Positive and Negative Syndrome Scale or Brief Psychiatric Rating Scale) and the pooled relative risk with random effects, with their respective 95% confidence intervals. We also calculated the necessary sample sizes in studies in which the study drug is compared to a typical antipsychotic or placebo. RESULTS: The pooled efficacy rates observed were 40.8%, 34.9% and 21.3% for the atypical antipsychotics, typical antipsychotics and placebo, respectively. One hundred and sixty six patients would have to be included when a new drug is compared with placebo if calculation is based on a difference of 20% found between the atypical antipsychotic and placebo and 2,054 if the difference sought were that found between the atypical antipsychotic and the typical antipsychotic, i.e. 6%. The estimated therapeutic failures would be 115 of the 166 patients when the study drug is compared with placebo, and 1,274 failures in the 2,054 patients when the study drug is compared to the typical antipsychotic. CONCLUSIONS: Placebo controlled studies may reduce the number of individuals exposed to the harmful effects of ineffective drugs.

A Comparative Trial of Depot Pipothiazine

1986 ◽  
Vol 14 (2) ◽  
pp. 72-77 ◽  
Author(s):  
J Steinert ◽  
A Neder ◽  
E Erba ◽  
C R Pugh ◽  
C Robinson ◽  
...  
Keyword(s):  
Side Effects ◽  
Rating Scales ◽  
Rating Scale ◽  
Statistical Significance ◽  
Depression Scale ◽  
Psychotic Symptoms ◽  
Biochemical Tests ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Flupenthixol Decanoate

Thirty-nine chronic schizophrenic patients were selected for a 12-month double-blind evaluation of the effectiveness of pipothiazine palmitate (PPT) and flupenthixol decanoate (FPX) in the maintenance management of their illness. Allocation was at random and, in order to allow constant injection intervals, the patients typically received every 2 weeks either 40 mg of flupenthixol decanoate or alternating injections of 100 mg of pipothiazine palmitate and placebo. At monthly intervals the patients were assessed using both a battery of rating scales (which included the Brief Psychiatric Rating Scale (BPRS), the Extrapyramidal Symptoms Rating Scale (EPS)) and a general side-effects evaluation. At 3-monthly intervals they were also rated on the Comprehensive Psychiatric Rating Scale (CPRS) and the Zung Depression Scale. Haematological and biochemical tests were performed every 3 months. Both drugs provided good control of psychotic symptoms and side-effects were not troublesome. No substantial difference was detected on the CPRS and the Zung scales. There was a trend in favour of PPT on the BPRS survey, detectable at 6 months and reaching statistical significance by 12 months. We conclude that the PPT regime is at least as effective as the FPX treatment and probably more so. It is possible that even longer periods of control could be obtained with PPT.

Aripiprazole is effective for the improvement of psychotic symptoms in patients with dementia with lewy bodies

2016 ◽  
Vol 33 (S1) ◽  
pp. S543-S543
Author(s):  
Y. Kikuchi ◽  
T. Kanbayashi ◽  
T. Shimizu
Keyword(s):  
Dementia With Lewy Bodies ◽  
Rating Scale ◽  
Clinical Status ◽  
Lewy Bodies ◽  
Study Endpoint ◽  
Psychotic Symptoms ◽  
Clinical Dementia Rating ◽  
The Mean ◽  
Competing Interest ◽  
Psychiatric Rating Scale

ObjectiveDementia with lewy bodies (DLB) is commonly considered the second most common form of dementia. The purpose of this study is to investigate the treatment effects of aripiprazole in patients with DLB.MethodsEleven patients who had meet the criteria for DLB participated in this study. The presence of psychotic symptoms was confirmed by scores of either the delusions or hallucinations items of the Neuropsychiatric Inventory (NPI) score. Patients who had 25 or more on the Mini-mental State Examination Scale (MMSE) at the entry or having brain damage were excluded. Aripiprazole was initiated at a low dose (3 or 6 mg/day) and titrated to higher doses at 2-weeks intervals or more rapidly based on investigator's judgment. Previous medications prior to aripiprazole administration were not changed through this trial. Patient's clinical status was assessed at baseline, then 2 weeks during the study by using NPI, Clinical Global Impression (CGI) and Brief Psychiatric Rating Scale (BPRS) to measure psychotic behavioral symptoms, and Simpson-Angus Scale (SAS) to measure parkinsonism symptoms. Clinical Dementia Rating (CDR) and MMSE were carried out at screening and end point to evaluate cognitive function.ResultsThe mean scores of the SAS and CDR were significantly decreased at the study endpoint compared to baseline. The mean scores of the NPI and BPRS improved up until 4 weeks after having started aripiprazole. After 4 weeks, improvements slowed. The mean score of the CGI-S was decreased up until 8 weeks.ConclusionThis study shows that aripiprazole may be effective for the treatment of psychotic symptoms in patients with DLB.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Effects of Language and Related Variables on the Expression of Psychopathology in Mexican American Psychiatric Patients

1981 ◽  
Vol 3 (2) ◽  
pp. 145-160 ◽  
Author(s):  
Criselda Segovia Price ◽  
Israel Cuellar
Keyword(s):  
Mental Health Professionals ◽  
Verbal Fluency ◽  
Mexican American ◽  
English Language ◽  
Rating Scale ◽  
Psychiatric Patients ◽  
Self Disclosure ◽  
Psychiatric Rating ◽  
The Difference ◽  
Psychiatric Rating Scale

Thirty-two Mexican American patients at the Bilingual/Bicultural Unit at the San Antonio State Hospital participated in a study that investigated the effect of interview language on the expression of psychopathology and the relationship of this effect to the variables of verbal fluency, acculturation, and self-disclosure. The patients were interviewed in separate Spanish- and English-language interviews that were videotaped. The videotaped interviews were then independently rated by bicultural/bilingual mental health professionals who used the Brief Psychiatric Rating Scale to determine the extent of psychopathology expressed by the patients during each interview. The patients were found to significantly express more symptomatology indicative of psychopathology during the Spanish interview. In addition, verbal fluency, acculturation, and self-disclosure were found to be significant multiple predictors of the difference in expressed psychopathology in the two interviews. Under different forms of analysis, verbal fluency and acculturation were also found to be unique predictors of this difference.

scholarly journals Carbamazepine for acute psychosis with eeg abnormalities

2004 ◽  
Vol 61 (4) ◽  
pp. 399-403
Author(s):  
Maja Ivkovic ◽  
Aleksandar Damjanovic ◽  
Dragan Marinkovic ◽  
Vladimir Paunovic
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
Statistical Significance ◽  
Convincing Evidence ◽  
Antipsychotic Treatment ◽  
Acute Psychosis ◽  
Eeg Abnormalities ◽  
Psychiatric Rating Scale ◽  
Adjuvant Drug Therapy ◽  
Paranoid Psychosis

Aim. To investigate the efficacy of carbamazepine as adjuvant drug therapy in acute paranoid psychosis with associated EEG abnormalities, compared to sole antipsychotic treatment. Methods. Eleven medication-naive patients diagnosed with acute paranoid psychosis with associated EEG abnormalities were divided into two treatment groups: sole fluphenazine group, with flexible dosing of 5-10 mg/day (n=6), and carbamazepine group (n=5) with the addition of carbamazepine (600 mg/day) to fluphenazine treatment. Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and EEG were assessed on the baseline and after 6 weeks of treatment. Paired and two-tailed t-tests were used for statistical significance. Results. All the patients showed significant improvement of mental state after 6 weeks of treatment with no significant differences in CGI, BPRS, and total SANS scores in relation to the therapy with carbamazepine. Nevertheless, after 6 weeks of the treatment, EEG findings were significantly better in carbamazepine group, in relation to the findings from the onset of the treatment, as well as in comparison to sole fluphenazine group. Conclusion. Although carbamazepine stabilized abnormal brain electrical activities it seemed that the associated EEG abnormalities were not significant for acute psychosis observed. These preliminary results suggested that there was no convincing evidence that carbamazepine was efficient as the augmentation of antipsychotic treatment for patients with both acute paranoid psychosis and EEG abnormalities.

Crisis Dialogue for Acute Psychotic State and Ethical Difficulties: What Do You Do When Trials Are Interrupted Because Clinicians Find the Intervention Too Effective?

2015 ◽  
Vol 17 (1) ◽  
pp. 45-59
Author(s):  
Bertrand Graz ◽  
Gilles Bangerter ◽  
Alexia Stantzos ◽  
Henri Grivois
Keyword(s):  
Rating Scale ◽  
Statistical Significance ◽  
Ethical Problem ◽  
Controlled Study ◽  
Perceived Effectiveness ◽  
Usual Treatment ◽  
Working Alliance Inventory ◽  
Psychotic State ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Clinical studies carry with them a paradox: The more obviously efficient an intervention is, the more ethical problems its trials pose. This article discusses the ethical problem of breached equipoise principle because of the perceived effectiveness of a nonblindable verbal technique, crisis dialogue (CD). CD is designed to help establish a therapeutic relationship with persons in a suspected psychotic state. In a pilot randomized controlled study in Yverdon, Switzerland (usual treatment vs. usual treatment + CD), after inclusion of 30 patients, clinicians expressed a consensual opinion that CD was effective in most cases. Following their opinion, the joint clinical and research team decided that the study had to be discontinued and that CD should be tried with all patients for ethical reasons. This poses an ethical problem with potential far-reaching consequences: In this interrupted study, differences between groups in terms of clinical outcome (Brief Psychiatric Rating Scale, Clinical Global Impression), therapeutic alliance (Working Alliance Inventory, Difficult Doctor–Patient Relationship Questionnaire), and patient satisfaction were consistent in favoring CD, but these differences did not reach statistical significance in most measurements. The early interruption of the study because of perceived effectiveness of the intervention can be seen as unethical as well because chances were high that a larger sample would have shown more conclusive results, allowing for faster introduction of CD in various clinical settings with corresponding improvement of patient care.

Commentary

2008 ◽  
Vol 13 (6) ◽  
pp. 8-8
Author(s):  
Richard T. Katz
Keyword(s):  
Mental Illness ◽  
Behavioral Disorders ◽  
Rating Scale ◽  
Behavioral Disorder ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mental And Behavioral Disorders

Abstract The author, who is the editor of the Mental and Behavioral Disorders chapter of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, comments on the previous article, Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches in this issue of The Guides Newsletter. The new Mental and Behavioral Disorders (M&BD) chapter, like others in the AMA Guides, is a consensus opinion of many authors and thus reflects diverse points of view. Psychiatrists and psychologists continue to struggle with diagnostic taxonomies within the Diagnostic and Statistical Manual of Mental Disorders, but anxiety, depression, and psychosis are three unequivocal areas of mental illness for which the sixth edition of the AMA Guides provides M&BD impairment rating. Two particular challenges faced the authors of the chapter: how could M&BD disorders be rated (and yet avoid an onslaught of attorney requests for an M&BD rating in conjunction with every physical impairment), and what should be the maximal impairment rating for a mental illness. The sixth edition uses three scales—the Psychiatric Impairment Rating Scale, the Global Assessment of Function, and the Brief Psychiatric Rating Scale—after careful review of a wide variety of indices. The AMA Guides remains a work in progress, but the authors of the M&BD chapter have taken an important step toward providing a reasonable method for estimating impairment.

D-test: A New Test for Analyzing Scale Invariance Using Symbolic Dynamics and Symbolic Entropy

Methodology ◽  
2011 ◽  
Vol 7 (3) ◽  
pp. 88-95 ◽  
Author(s):  
Jose A. Martínez ◽  
Manuel Ruiz Marín
Keyword(s):  
Symbolic Dynamics ◽  
Scale Invariance ◽  
Rating Scales ◽  
Rating Scale ◽  
Marketing Research ◽  
Response Patterns ◽  
Measurement Scales ◽  
Improve Measurement ◽  
Entropy Measures ◽  
The Difference

The aim of this study is to improve measurement in marketing research by constructing a new, simple, nonparametric, consistent, and powerful test to study scale invariance. The test is called D-test. D-test is constructed using symbolic dynamics and symbolic entropy as a measure of the difference between the response patterns which comes from two measurement scales. We also give a standard asymptotic distribution of our statistic. Given that the test is based on entropy measures, it avoids smoothed nonparametric estimation. We applied D-test to a real marketing research to study if scale invariance holds when measuring service quality in a sports service. We considered a free-scale as a reference scale and then we compared it with three widely used rating scales: Likert-type scale from 1 to 5 and from 1 to 7, and semantic-differential scale from −3 to +3. Scale invariance holds for the two latter scales. This test overcomes the shortcomings of other procedures for analyzing scale invariance; and it provides researchers a tool to decide the appropriate rating scale to study specific marketing problems, and how the results of prior studies can be questioned.

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