Guideline for the pharmacotherapy of treatment-resistant schizophrenia. Royal College of Psychiatrists of Thailand.

The authors proposed to develop an evidence-based guideline relevant to drug use for treatment-resistant schizophrenia (TRS), which will be called "Guideline for the Pharmacotherapy of Treatment-Resistant Schizophrenia or PTRS Guideline". The authors performed a MEDLINE search (between 1966 and December 1998) and classified the study designs of those trials by using the system proposed by the Agency for Health Care Policy and Research (AHCPR). The levels of evidence were graded and recommendations were made by the use of a system modified from that of the AHCPR. One hundred and sixty-three articles met the inclusion criteria for the review. For a schizophrenic patient who does not respond to a classical antipsychotic, physicians should switch from the first classical antipsychotic to the second one, which belongs to a different class. A schizophrenic patient who does not respond to at least two adequate trials of classical antipsychotics should be classified as a TRS patient. Clozapine should be considered as a first-line treatment for TRS. Risperidone should be considered in a TRS patient who refuses to have regular blood monitoring or has contraindication for clozapine. Physicians should use this guideline to accompany others that suggest the overview of treatment for schizophrenia. Appropriate application and the limitations of the guideline are also discussed.

Zopiclone in the treatment of insomnia: an open clinical trial.

The purpose of this study was to examine the efficacy and adverse effects of zopiclone in Thai psychiatric patients. Thirty-two insomniac outpatients with a variety of diagnoses participated in this study. Zopiclone at the dose of 7.5-15 mg was administered 15 minutes before bedtime. The sleep-questionnaire items included: 1) sleep induction; 2) duration of sleep; 3) number of awakenings, 4) sleep quality; 5) dream incidence; and 6) condition in the morning. The mean scores of each item were compared by using pair t-test. One week after treatment, significant improvement was found in all items, except item 5. In comparison between sleep at 1 week and 3 weeks after treatment, further improvement was still found in the first three items. The adverse effects found were bitter taste, drowsiness, and headache. In conclusion, zopiclone is an effective hypnotic with few adverse effects.