Management of Relapse in Schizophrenia

Relapse of psychotic symptoms in Schizophrenia occurs in up to 40% of patients within a year of being hospitalised. A relapse may be secondary to any individual factor or several factors acting concomitantly. Risk factors that can precipitate a relapse in Schizophrenia are: significant residual psychopathology, poor compliance to medication, poor insight, substance misuse, interactions with other medication, poor social support, increased stress and caregivers with high expressed emotions. A thorough history and assessment should be conducted to elicit all contributory factors and appropriate interventions undertaken to address them in order to prevent the onset of a full blown relapse or to help the individual to achieve remission of symptoms. It is necessary to implement a proactive approach towards the prevention of relapses by using strategies such as psychoeducation and early identification of relapse signatures. More importantly, it should be emphasised that empowerment of the individuals in understanding and managing their illness is crucial.

Treated Hypertensives with Good Medication Compliance are Still in a State of Uncontrolled Blood Pressure in the Japanese Elderly

Objectives: Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population. Methods: The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)³140 and/or diastolic BP (DBP)³90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance. Results: Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%. Conclusions: Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.

Treated hypertensives with good medication compliance are still in a state of uncontrolled blood pressure in the Japanese elderly

<p><b>OBJECTIVES</b>Blood pressure (BP) is poorly controlled in many countries. Poor compliance was suggested as the main cause for poor BP control. The purpose of this study was to examine the association between compliance and the control of both casual blood pressure (BP) and 24-hr ambulatory BP in a Japanese elderly population.</p><p><b>METHODS</b>The study was a cross-sectional survey. Casual BP and 24-hr ambulatory BP were measured at home. Hypertension was defined as casual systolic BP (SBP)≧140 and/or diastolic BP (DBP)≧90 mmHg, or as treated hypertension. A compliance rate of greater than 80% by the pill count method was defined as good compliance.</p><p><b>RESULTS</b>Of the 178 treated hypertensives, 82.6% showed good compliance. Between the treated hypertensives with good compliance and those with poor compliance, no significant difference was found in either casual BP or ambulatory BP. Of the treated hypertensives with good compliance, the prevalence of achieved target ambulatory BP, i.e., daytime BP<135/85 mmHg, nighttime BP<120/75 mmHg, and 24-hr BP<125/80 mmHg, was, respectively, 35.4%, 43.5%, and 20.4%.</p><p><b>CONCLUSIONS</b>Casual BP and 24-hr ambulatory BP were poorly controlled in the community-living elderly although many of the treated hypertensives showed good compliance. It is unlikely that this inadequate control of hypertension is due to poor compliance on the part of the subjects.</p>