title: Effectiveness and tolerability of oral ziprasidone in psychiatric inpatients with an acute exacerbation of schizophrenia or schizoaffective disorder: a multicenter, prospective, and naturalistic study. Switching clozapine responders to olanzapine. Subjective response and attitudes toward antipsychotic drug therapy during the initial treatment period: a prospective follow‐up study in patients with schizophrenia Patients' opinions of olanzapine and risperidone following long-term treatment: results from a cross-sectional survey. A two-year prospective study of treatment compliance in patients with schizophrenia. Effectiveness, safety, and tolerability of ziprasidone for treating schizophrenia patients undergoing usual care: A 12-month, open-label, flexible-dose, naturalistic observational trial Safety, effectiveness, and quality of life of olanzapine in first-episode schizophrenia: a naturalistic study A RATING SCALE FOR EXTRAPYRAMIDAL SIDE EFFECTS Psychological predictors of insight and compliance in psychotic patients. Differences of satisfaction with medication between patients with schizophrenia treated with typical antipsychotics and atypical antipsychotics. Amisulpride versus risperidone in the treatment of schizophrenic patients: a double-blind pilot study in Taiwan.
abstract: OBJECTIVE This prospect i ve , uncontrolled , and naturalistic study aim ed to evaluate the effectiveness and tolerability of oral ziprasidone in psychiatric in patients with an acute exacerbation of schizophrenia or schizoaffective disorder treated in the clinical practice setting . METHOD Patients had to be at least 18 years old and meet DSM-IV-TR criteria for acute exacerbation of schizophrenia or schizoaffective disorder . Patients were followed until discharge and were evaluated with the Brief Psychiatric Rating Scale ( BPRS ) , Clinical Global Impressions ( CGI ) scale , Drug Attitude Inventory , and the Scale to Assess Unawareness of Mental Disorder .  Ziprasidone dose requirements , dose escalation , discontinuation of treatment , and the use of any concomitant medication including cotreatment with other antipsychotics were established individually according to the clinical judgment of each investigator . The study was conducted from February 2005 to June 2007 . RESULTS We included a total of 196 patients ( intent-to-treat population ) , 9 ( 5 % ) of whom discontinued treatment with ziprasidone ( 3 because of side effects ) . The mean ( SD ) length of stay was 23.4 ( 34.2 ) days . The mean ( SD ) dose at discharge was 186.3 ( 67.6 ) mg/day , and the median dose was 160 mg/day ( interquartile range , 120 - 240 mg/day ) . Response rates at the endpoint , according to BPRS and CGI criteria , were 74 % ( 95 % CI = 68 % to 80 % ) and 67 % ( 95 % CI = 61 % to 74 % ) , respectively . Progressive and statistically significant improvements in all BPRS scores and CGI-Severity of Illness scores were observed from the first week through discharge . All changes from baseline to the study endpoint for BPRS and CGI scores were clinical ly relevant , with effect sizes greater than 0.80 . The insight into illness and the attitude toward medication also improved significantly over the course of the study . Ziprasidone was well tolerated . CONCLUSION Although our results should be interpreted with caution because of the uncontrolled design of our study , they suggest that , in acutely ill in patients with schizophrenia or schizoaffective disorder , the use of ziprasidone under routine clinical conditions is associated with a rapid and progressive improvement in psychopathologic symptoms and a clinical ly relevant improvement in insight into their illness BACKGROUND Clozapine is an atypical antipsychotic indicated for the management of severely ill patients with schizophrenia who have failed to respond adequately to st and ard drug treatment . The significant risk of agranulocytosis and seizure associated with clozapine has led to the restrictions in its use . Additionally , drug-induced sedation , sialorrhea , enuresis , and weight gain are often cited as problematic consequences of clozapine treatment . Our primary objective was to determine the effectiveness and safety of a method of slow cross-titration from clozapine to olanzapine among patients responsive to clozapine treatment but experiencing medication-induced adverse events . METHOD Changes in symptomatology , mood , subjective response , and safety were examined in 20 out patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder who converted from clozapine to olanzapine .  Patients were considered clozapine-responsive as evidence d by improved social function and decreased symptoms with clozapine therapy ; however , they were interested in alternative pharmacologic treatment because of clozapine-related side effects . RESULTS Equivalent efficacy of olanzapine to clozapine was found in 90 % of the patients ( 18/20 ) in the study group , without rehospitalization or suicidal behavior in any of the patients . Also notable was a reduction in drug-induced side effects and improved subjective response to pharmacotherapy . CONCLUSION The successful conversion from clozapine to olanzapine has the potential to provide great benefits for the patient , including reducing drug-induced side effects while maintaining symptom control . These preliminary results suggest that further research on converting clozapine responders to olanzapine is warranted Objective : In this prospect i ve study , patients with schizophrenia were followed up for 3 months to investigate the impact of sociodemographic factors , psychopathology , change in psychopathology and side effects on subjective response and attitudes toward antipsychotics  during the initial treatment period INTRODUCTION The present study compares the subjective responses of patients in the stable phase of schizophrenia being treated with either olanzapine or risperidone .  METHODS Several well-established , self-report inventories were used in this investigation , providing a means of assessing the impact of these medications from the perspective of the patient . RESULTS Patients r and omly sample d from a continuing care clinic had been receiving treatment with olanzapine and risperidone for an average of 140 weeks and 225 weeks , respectively . The two treatment groups report highly positive attitudes toward their medication and a relatively high overall level of well-being and health-related quality of life . All patients report high levels of satisfaction with the mental health services they receive and their general health status . Olanzapine-treated patients were more likely to report reduced social and family interaction , as well as reduced sexual behavior and less participation in active recreational and pastime activities .  Patients on olanzapine also reported greater difficulty in thinking clearly and more feelings of uselessness and of being lost and alone . The occurrence of antipsychotic-induced tardive dyskinesia and akathisia was low in both treatment groups . DISCUSSION Results point to a high level of subjective tolerability for both olanzapine and risperidone , with few differences between the two medications on the subjective dimensions of outcome assessed in this study . Future studies should exp and on the findings here , building on the limitations toward a large study including a comparison group receiving long-term treatment with typical antipsychotics . Ultimately , the goal should be the incorporation of patient-oriented assessment s into routine clinical practice . This is particularly important given the relationship among satisfaction with treatment , compliance , and quality of life The study is a prospect i ve investigation of the factors associated with  treatment compliance  in 61 patients discharged from hospital with a ward diagnosis of schizophrenia . All cases were classified using reliable diagnostic criteria and all were followed up for two years . Compliance was assessed by inspection of records and by analysis of urine .  Sociodemographic factors and illness variables were unrelated to compliance . Some aspects of a patient 's insight and attitude , namely , a belief that medication had helped during the admission , a stated willingness to take treatment after discharge and a generally optimistic outlook , were associated with improved compliance . Other variables which showed such an association were the absence of the drug side-effect akinesia , good previous compliance and voluntary , as opposed to compulsory , admission to hospital OBJECTIVE This is a first report from a long-term study aim ed to evaluate efficacy , safety , tolerability , cognitive functioning , and quality of life outcomes during ziprasidone treatment of chronic schizophrenia patients in the " real-world " . METHOD Seventy clinical ly unstable schizophrenia patients with persistent symptoms or troublesome side effects were assigned to a 12-month , open-label , flexible-dose ( 40 - 160 mg/day ) , large-scale , naturalistic trial . Outcome measures were taken at baseline , 6 , and 12 months , and included the Positive and Negative Syndrome Scale ( PANSS ) , the Clinical Global Impression ( CGI-S ) scale , the Global Assessment of Functioning Scale ( GAF ) scores , treatment-emergent adverse events , body weight , and drug attitude . RESULTS Thirty-two patients fully completed the study protocol . A discontinuation of treatment for any cause occurred in 54.3 % of patients ; the mean time until discontinuation was 4.4 + /- 2.7 months . A discontinuation due to lack of clinical efficacy was more predominantly linked to patient perception ( 25.7 % ) than to physicians ' conclusions alone ( 8.6 % ) , adverse events ( 11.4 % ) , and other reasons ( 8.6 % ) . After controlling daily dose of ziprasidone , concomitant medications and sex , ANCOVA revealed improvement in PANSS factors , and global functioning among patients who had completed the study . Improvement in PANSS and GAF dimensions was evident at a 6-month visit , and it continued until the endpoint . When a cutoff of 20 % improvement of PANSS total scores was used , the response rate among completers was 43.8 % . Most common side effects were : fatigue , sleep disturbances , and headache . Ziprasidone did not appear to be linked to weight gain . CONCLUSION This study suggests that ziprasidone may be beneficial for long-term treatment of schizophrenia patients in terms of severity of symptoms , and general functioning . Ziprasidone is well tolerated during the long-term treatment of chronic schizophrenia patients undergoing usual care OBJECTIVE This study evaluated the effectiveness , safety , and quality of life ( Qol ) offered by olanzapine in first-episode schizophrenia . METHOD One hundred and eighty-two patients with first-episode schizophrenia ( ICD-10 ) drawn from a larger , naturalistic , study were evaluated after 6 months of treatment with olanzapine , risperidone , or conventional antipsychotics ( CA ) . Clinical status was assessed using the Clinical Global Impression-Severity ( CGI-S ) and Global Assessment of Function ( GAF ) . AWAD and EuroQol scales were used to evaluate patients ' attitude towards medication and Qol , respectively . RESULTS Subjects treated with olanzapine , risperidone , and CA showed similar improvements on CGI-S and GAF . Treatment-emergent , extrapyramidal symptoms were significantly lower in olanzapine-treated patients ( 17.8 % ) than in the risperidone ( 46.4 % ) and CA ( 62.2 % ) groups . Compared to CA , olanzapine and risperidone showed significantly greater improvement on the visual analog scale of EuroQol .  Olanzapine-treated patients also showed significantly improved AWAD scores . CONCLUSIONS In first-episode schizophrenia , atypical antipsychotics were effective , and improved Qol .  Olanzapine had a lower incidence of extrapyramidal symptoms and better subjective acceptance of medication A modification of an earlier rating scale for extrapyramidal system disturbance is described , and evidence for the validity and reliability of the scale is presented . The usefulness of the scale in studies of neuroleptic drugs is discussed . By its application it is possible to quantify extrapyramidal side effects and to separate them into four principal factors BACKGROUND A possible neuropsychological basis for poor insight in psychosis has been proposed . Consistent supporting evidence for this is lacking . METHOD Seventy-four consecutive acutely psychotic in- patients who were recruited for a r and omised controlled trial of compliance therapy  were given a battery of neuropsychological tests , along with a comprehensive clinical assessment , before and after the intervention . RESULTS Performance on neuropsychological tests improved during the patients ' admission and treatment in hospital , as did symptoms and levels of insight . Cognitive function showed no relationship to insight and compliance initially , and very little after the intervention . Factors related to insight and compliance prior to discharge included : diagnosis , attitudes to medication , side-effects , being a detained patient , and whether or not compliance therapy was given . CONCLUSIONS Clinical variables and attitudes to treatment appear to be more relevant to compliance and the development of insight in acute psychosis than neuropsychological impairment Many studies have demonstrated that atypical antipsychotics are superior to typical antipsychotics in that they have fewer side-effects and produce better improvement of cognitive deficits and quality of life in patients with schizophrenia . However , most of these studies dealt with objective indices assessed by research ers rather than subjective indices that are indeed important to patients themselves . In 126 patients with schizophrenia , annoyance of side-effects and psychotic symptoms , satisfaction with medication , wish to change medication , and knowledge of atypical antipsychotics  were assessed using question naires . Patients treated with typical antipsychotics complained less of annoyance of poor attention and concentration than those treated with atypical antipsychotics , which can be explained by increased awareness of these symptoms by the patients due to the improvement of cognitive function . There were no significant differences between the two groups in other variables . The present results that satisfaction and annoyance were similar between patients treated with typical antipsychotics and those with atypical antipsychotics , may partly explain why patients hesitated and rejected changing or shifting from typical to atypical antipsychotics . But because 98 of 126 patients did not know about atypical antipsychotics , it is important to educate the patients on the merits of atypical antipsychotics BACKGROUND AND PURPOSE The atypical antipsychotics , amisulpride and risperidone , have different receptor affinity characteristics . Although the relative efficacy of both drugs compared to conventional antipsychotics is well established , it remains unclear how the efficacy of amisulpride compares with risperidone . There have been no controlled studies comparing amisulpride to risperidone in Asian patients . The purpose of this study was to compare the efficacy and safety of amisulpride with that of risperidone in Taiwanese schizophrenic patients . METHODS Patients with productive positive symptoms ( n = 48 ) were enrolled into this double-blind , r and omized pilot study for 6 weeks . Patients received either amisulpride ( 400 - 800 mg/day ) or risperidone ( 4 - 8 mg/day ) . Positive and Negative Syndrome Scale ( PANSS ) , Clinical Global Impression ( CGI ) , Social and Occupational Functioning Assessment Scale ( SOFAS ) , and patients ' subjective responses to treatment were assessed during the trial period . Adverse events were recorded at each follow-up visit . RESULTS At the end of the trial , the mean dosage was 630 + /- 134 mg/day and 6.88 + /- 1.54 mg/day for amisulpride and risperidone , respectively . There was no significant difference in the reduction of the PANSS total score ( amisulpride -24.1 versus risperidone -28.4 , p = 0.999 ) , the PANSS positive subscale score ( amisulpride -6.8 versus risperidone -8.3 , p = 0.467 ) , the PANSS negative subscale score ( amisulpride -5.6 versus risperidone -6.4 , p = 0.999 ) , or the CGI score between the two groups . The extrapyramidal symptom ratings , the improvement in the SOFAS ( amisulpride 11.1 versus risperidone 10.0 ) and the subjective response ( amisulpride 82 % versus risperidone 83 % ) were comparable . No serious adverse events were recorded in either treatment group . There was a statistically significant body weight gain in the risperidone group . In contrast , there was a statistically , though not clinical ly , significant reduction of blood pressure and heart rate in the amisulpride group . CONCLUSIONS This study suggests that amisulpride is as effective as risperidone in the treatment of patients with schizophrenia . Both drugs were well tolerated , but had different side effect profiles
target: CONCLUSIONS This review provides some support to the notion that patients experiencing antipsychotic side-effects are at risk of developing more negative attitudes toward medication .
background: BACKGROUND Antipsychotics are associated with a wide range of side-effects .
  Many patients experience antipsychotics as unpleasant and something they would rather avoid , leading some of them to discontinue taking their medication .
  The importance of evaluating the patients ' perspective , especially their attitudes toward medication in the presence of side-effects , has long been emphasized .
  However , no definite conclusion has been made to date on the relationship between antipsychotic side-effects and attitudes toward medication .
  OBJECTIVES The objective of this systematic review was to determine the best available evidence regarding the impact of antipsychotic side-effects on attitudes toward medication in patients with schizophrenia and related disorders , which include schizoaffective and schizophreniform disorders .
  SEARCH STRATEGY The search aim ed to find published studies using a range of data bases .