Schizophrenia—Time to Commit to Policy Change Fleischhacker, W. Wolfgang; Arango, Celso; Arteel, Paul ...
Schizophrenia bulletin,
04/2014, Letnik:
40, Številka:
Suppl_3
Journal Article
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Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out ...the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.
A number of psychosocial treatments are available for persons with schizophrenia that include social skills training, cognitive behavioral therapy, cognitive remediation, and social cognition ...training. These treatments are reviewed and discussed in terms of how they address key components of functional recovery such as symptom stability, independent living, work functioning, and social functioning. We also review findings on the interaction between pharmacological and psychosocial treatments and discuss future directions in pharmacological treatment of schizophrenia. Overall, these treatments provide a range of promising approaches to helping patients achieve better outcomes far beyond symptom stabilization.
The Food and Drug Administration (FDA)-National Institute of Mental Health (NIMH)-Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) clinical trial guidelines for ...cognitive-enhancing drugs in schizophrenia and the MATRICS Consensus Cognitive Battery (MCCB) were designed to facilitate novel compound development in the treatment of cognitive impairments. Several studies have recently utilized the FDA-NIMH-MATRICS guidelines and MCCB and allow an evaluation of the feasibility of guideline implementation and MCCB performance. In light of the study results, we would recommend the following inclusion criteria revisions-(1) clinical status and symptom inclusion criteria: maximum allowed score for hallucinations and delusions should be increased from moderate to moderately severe and the negative symptom criterion should be dropped in phase 2 studies; (2) antipsychotic medication inclusion criteria: first-generation antipsychotics should be allowed, but only in the context of no concomitant anticholinergic agents and minimal extrapyramidal symptoms, and antipsychotic polypharmacy should be allowed in the absence of pertinent pharmacokinetic or pharmacodynamic considerations; and (3) people who use illicit substances should not be allowed in phase 1B or 2A proof-of-concept studies but may be included in phase 2B and 3 studies in which proof of effectiveness and generalizability of results become more important goals. These revisions are recommended to enhance recruitment while maintaining sufficient methodological rigor to ensure the validity of study results. The MCCB has been shown to have excellent psychometric characteristics, including reliability for multisite clinical trials, clinical relevance for real-world functioning, and possible sensitivity to behavioral treatment, and should continue to serve as the standard outcome measure for cognitive enhancement studies in schizophrenia.
Perylene diimide discotic columnar liquid‐crystalline mesophases (see Figure) can show very high electron mobilities under ambient conditions. While the mobilities are strongly dependent on sample ...morphology and processing conditions, mobilities as high as 1.3 cm2 V–1 s–1 are measured, greater than that of amorphous silicon.
A spin‐cast method is presented for the formation of phosphonic acid functionalized small molecule layers on solution‐processed ZnO substrates for use as electron collecting interlayers in organic ...photovoltaics. Phosphonic acid interlayers modify the ZnO work function and the charge carrier injection barrier at its interface, resulting in systematic control of V OC in inverted bulk heterojunction solar cells. Surface modification is shown to moderate the need for UV light‐soaking of the ZnO contact layers. Lifetime studies (30 days) indicate stable and improved OPV performance over the unmodified ZnO contact, which show significant increases in charge extraction barriers and series resistance. Results suggest that enhanced stability using small molecule modifiers is due to partial passivation of the oxide surface to molecular oxygen adsorption. Surface passivation while maintaining work function control of a selective interlayer can be employed to improve net efficiency and lifetime of organic photovoltaic devices. The modified cathode work function modulates V
OC via static energetic barriers and modulates contact conductivity by creating reversible and irreversible S‐shape current‐voltage characteristics as a result of kinetic barriers to charge transport.
Deposition of benzyl phosphonic acids and alkanethiol self‐assembled monolayers improve initial device performance, and have beneficial effect at mitigating the light‐soaking effect present after aging inverted architecture organic bulk heterojunction devices incorporating ZnO contact layers in air. The effect of a kinetic/transport barrier and a static energetic barrier resulting in formation of S‐shaped J–V curves is isolated.
Phosphonic acids act as robust surface modifiers on barium titanate (BT) nanoparticles (NPs) (see figure), affording homogeneous, high‐volume‐fraction composites of such NPs in polymeric hosts by ...simple solution processing. Pentafluorobenzyl phosphonic acid‐modified BT nanocomposite films in poly(vinylidenefluoride‐co‐hexafluoropropylene) show large relative permittivities and unusually high dielectric breakdown strengths.
Repurposing Drugs for Cognition in Schizophrenia Yang, YS; Marder, SR; Green, MF
Clinical pharmacology and therapeutics,
February 2017, 2017-Feb, 2017-02-00, 20170201, Letnik:
101, Številka:
2
Journal Article
Recenzirano
Currently approved treatments for schizophrenia only minimally affect the cognitive features of the illness that are the most closely related to disability. Hence, there is now considerable effort to ...repurpose drugs for schizophrenia, and to seek agents that can improve cognition by targeting receptor systems other than the dopaminergic system. The results of these studies have been mixed thus far; however, this continues to be a high‐priority area of schizophrenia research and an important unmet need.
The ability of nonlinear optical materials to transmit, process and store information forms the basis of emerging optoelectronic and photonic technologies. Organic chromophore-containing polymers, in ...which the refractive index can be controlled by light or an electric field, are expected to play an important role.
In two double-blind trials conducted in North America, 513 patients with chronic schizophrenia received risperidone, haloperidol, or placebo. In the present study, combined data from the two trials ...were analyzed.
Patients were randomly assigned to receive placebo, fixed doses of risperidone (2, 6, 10, and 16 mg/day) or 20 mg/day of haloperidol for 8 weeks. Factor analysis of scores on the Positive and Negative Syndrome Scale (PANSS) produced five dimensions (negative symptoms, positive symptoms, disorganized thought, uncontrolled hostility/excitement, and anxiety/depression), similar to the five dimensions of previous factor-analytic studies of PANSS data.
Mean changes (symptom reductions) in PANSS factor scores from baseline to treatment Weeks 6 and 8 were significantly greater in patients receiving 6-16 mg/day of risperidone than in patients receiving placebo or haloperidol. The advantages of risperidone were greatest for negative symptoms, uncontrolled hostility/excitement, and anxiety/depression. Even at the lowest dose, 2 mg/day, risperidone was significantly (p < or = .05) superior to haloperidol in reducing negative symptoms. The differences in outcomes between risperidone and haloperidol on PANSS scores were not related to extrapyramidal symptoms.
Risperidone produced significantly (p < or = .05) greater improvements than haloperidol on all five dimensions. The large between-group differences on negative symptoms, hostility/excitement, and anxiety/depression suggest that risperidone and other serotonin/dopamine antagonists have qualitatively different effects from those of conventional antipsychotic agents.
The purpose of this study was to investigate the safety and efficacy of risperidone in the treatment of schizophrenic patients and determine its optimal dose.
This double-blind study included 388 ...schizophrenic patients drawn from 20 sites in the United States. Patients were randomly assigned to 8 weeks' treatment with placebo, one of four doses of risperidone (2, 6, 10, or 16 mg), or 20 mg of haloperidol daily.
Clinical improvement (20% reduction in total scores on the Positive and Negative Syndrome Scale for Schizophrenia) at the study end point was shown by 35% of the patients receiving 2 mg of risperidone, 57% receiving 6 mg, 40% receiving 10 mg, and 51% receiving 16 mg; and by 30% receiving haloperidol and 22% receiving placebo. Statistically significant differences in clinical improvement were found between 6 and 16 mg of risperidone versus placebo and versus haloperidol. Positive symptom scores were significantly lower after 6, 10, and 16 mg of risperidone and 20 mg of haloperidol than placebo; negative symptom scores, however, were reduced significantly, compared with placebo, only after 6 and 16 mg of risperidone. The incidence of extra-pyramidal side effects (measured by the Extrapyramidal Symptom Rating Scale) was significantly higher in patients treated with 16 mg of risperidone or 20 mg of haloperidol than placebo. The results indicate that the optimal daily dose of risperidone for most schizophrenic patients in this study was 6 mg; this dose was as effective as 16 mg, and the incidence of extrapyramidal symptoms in patients receiving 6 mg of risperidone was no higher than that in patients receiving placebo.
Risperidone is a safe antipsychotic that is effective against both the positive and negative symptoms of schizophrenia.
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