Appropriateness & Effectiveness Of Drug Therapies

Question 0

Negative symptoms

Answer 0

Typicals do not treat negative symptoms very well, but Atypicals do a better job with negative symptom and drug resistant patients.
Atypicals are more expensive and their superior effectiveness is disputed.

Question 1

Positive symptoms

Answer 1

Typicals and Atypicals are good at controlling positive symptoms and do allow schizos to live outside institutional care.

Question 2

Acute v Chronic

Answer 2

Acute: symptoms appear abruptly and then improve somewhat.
This repeats and patient alternates between active and residual episodes.
Often leads to chronic schizo.
Chronic: long term version, mostly negative symptoms, including lack of activity, motivation, speech, volition, emotional flattening and self neglect.
Drugs are essential for treatment of acute episodes which is uncontroversial as both have high clinical efficiency.
Neuroleptics don’t work on all patients with positive symptoms.
6.5% were unable to be discharged after the first acute episode resulting in hospitalisation.
16% failed to respond to treatment within one year.
Some recover naturally.

Question 3

Clozapine

Answer 3

Atypical that’s particularly effective at treating drug resistant patients.
25-50% of patients with stubborn symptoms will respond positively in 12 months.
Significant dangerous side effects so considered a last resort.
Can cause agranulocytosis and is fatal in 1.3% of clozapine takers.
5% chance if seizures and sudden loss of consciousness can occur.

Question 4

Response to Typicals and Atypicals

Answer 4

20-30% of patients do not respond or are seriously intolerant of neuroleptics.
Which drug to give is based in benefits, risks and costs.
Atypicals and typicals produce a good response 40-50% of the time and a partial response 20-30% of the time.