The Feasibility Test of Korean Medication Algorithm for the Treatment with Schizophrenic Patients(III): The Influence of Therapeutic Environment on Application of Korean Medication Algorithm Project for Schizophrenia / 대한정신약물학회지

ABSTRACT

OBJECTIVE: Korean Medication Algorithm Project(KMAP) for schizophrenia was started in 2001. Phase II of this algorithm project for schizophrenia was a feasibility trial and was done to investigate suitability of the algorithm. The purpose of this paper was to evaluate the influence of the therapeutic environment in application of Korean medication algorithm project for schizophrenia. METHOD: A total 108 schizophrenic patients were enrolled at 16 general hospitals and at 3 mental hospitals. All subjects were treated and evaluated according to the algorithm. After the application of the algorithm, clinical effects, switching tendency of antipsychotics and degree of satisfaction for algorithm were compared between general hospitals and mental hospitals. RESULT: There were no significant demographic differences in the two hospital groups. But, cognitive and obsessive symptoms were significantly more severe in mental hospital patients. In general hospital, transitions between each treatment stages were more frequent than in mental hospital. After 4 months of antipsychotic medications trial, most patients were still in the stage 1 (83.3%) in mental hospital group compared to 51.85% of patients in general hospital group. After 4 months of algorithm trial, changes in PANSS (32.85+/-18.87) and CGI (3.47+/-1.81) in general hospital group were significantly greater than those in mental hospital group. Necessities of treatment algorithm were more emphasized by clinician working at the mental hospitals. Overall, degrees of satisfaction for treatment algorithm were not significantly different between two hospital groups. CONCLUSION: These results could be due to the different characteristics of patients or therapeutic environment between the two groups. Also, the resources needed to implement the algorithm may be different between the two groups. To use the Korean Medication Algorithm for schizophrenia with treatment as usual, the difference between therapeutic environments should be considered.