Opinions of French patients with schizophrenia regarding injectable medication.

BACKGROUND: Use of patient-reported outcomes to assess the care of individuals with schizophrenia is increasing. We describe a survey (questionnaire) that evaluates patient opinions on long-acting injectable antipsychotic medication. METHODS: Psychiatrists throughout France selected consenting patients with schizophrenia who had received at least three months' treatment with a long-acting injectable antipsychotic (either typical or atypical) as outpatients to be interviewed by professional interviewers. RESULTS: A total of 206 patients were interviewed at 19 sites. Ninety-five percent of the patients had been treated with more than one form of dosage; for these individuals, injections were the favored dosage form, being preferred by 47% (compared with 35%, 7%, and 1% expressing a preference for oral tablets, drinkable solutions, and orally disintegrating tablets, respectively, whilst 10% of patients did not express a preference). Over two-thirds of the interviewees (67%) said they felt better having received an injectable treatment than they felt before, and over half the patients (51%) considered injectable therapy to be more effective than other medication. In addition, the majority of the sample (70%) felt better supported in their illness by virtue of regular contact with the doctor or nurse who administered their injection. Patients also reported that injectable treatment could impact positively on their plans and aspirations, with the most frequent consideration for the future relating to finding a job (49% of the sample). CONCLUSION: In this survey, patients with schizophrenia had favorable opinions on injectable medication. Ultimately, positive experiences associated with the treatment of schizophrenia in patients receiving long-acting injectable medication may influence the prescription of such therapy by health care providers.

Palliative portal vein stent placement in malignant and symptomatic extrinsic portal vein stenosis or occlusion.

This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean +/- standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg +/- 4.6 to 1.1 mmHg +/- 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean +/- SD follow-up of 134.4 +/- 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 +/- 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 +/- 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.

A descriptive, open-label, long-term follow-up survey of psychotic patients receiving risperidone long-acting injectable: Preliminary results.

Objective. To assess clinical development in patients with psychotic disorders who received risperidone long-acting injectable (RLAI) in combination with psychosocial interventions as part of daily clinical practice in France. Methods. In this 18-month survey, patients were started on bi-monthly RLAI injections and integrated in a psychosocial treatment programme. Clinical progression was evaluated using the Clinical Global Impression of Severity (CGI-S) and Global Assessment of Functioning (GAF) scales. In addition, data on patient characteristics, adherence, RLAI dosage, concomitant medications and rates and durations of hospitalization were collected. Results. Of the total of 120 patients included in the survey, 95 (79.2%) had previously received other treatments. Non-adherence was the most frequently reported reason for changing to RLAI (93 patients, 97.9%). With RLAI treatment, mean CGI-S scores improved from 5.6±0.5 at baseline to 3.6±1.1 at 18 months, whilst mean GAF scores increased from 34.0±12.7 to 67±13.5 (both P<0.0001). Furthermore, patients had fewer and shorter hospitalizations during the 18 months of RLAI treatment, compared to the preceding 18 months. Conclusions. Patients with psychotic disorders benefited from RLAI treatment in combination with psychosocial interventions, as shown by improvements in their clinical status and functioning and reduced hospitalization rates.

Cetuximab shows activity in colorectal cancer patients with tumors for which FISH analysis does not detect an increase in EGFR gene copy number.

BACKGROUND: EGFR (epidermal growth factor receptor) gene gain assessed by FISH (fluorescence in situ hybridization) has been shown to be predictive of response to EGFR-targeted therapies in patients with non-small cell lung cancer. The aim or our study was to relate the EGFR gene copy number to therapeutic results in patients with metastatic colorectal cancer (CRC) treated with a cetuximab-containing regimen. METHODS: Forty-seven patients with metastatic CRC treated with a cetuximab-containing regimen between August 2004 and September 2006 were included in our study. EGFR status was assessed by immunohistochemistry (IHC) and by FISH on fixed paraffin-embedded sections of tumor specimens. RESULTS: By IHC (n = 47), 39 patients (83%) had EGFR-positive tumors. EGFR gene copy gain was detected in 8 (19.5%) of 41 tumors. Neither EGFR expression assessed by IHC nor EGFR gene copy gain assessed by FISH were statistically significantly correlated with objective response rate, disease control rate, progression-free survival, and overall survival. Of the 33 patients whose tumors were FISH negative, 8 patients (24.2%) had a partial response, and 10 (30.3%) had stable disease. CONCLUSIONS: EGFR FISH analysis does not seem to be a sufficiently robust test for selecting candidate CRC patients for cetuximab therapy.

Long-term pharmacoclinical follow-up in schizophrenic patients treated with risperidone. Plasma and red blood cell concentrations of risperidone and its 9-hydroxymetabolite and their relationship to whole blood serotonin and tryptophan, plasma homovanillic acid, 5-hydroxyindoleacetic acid, dihydroxyphenylethyleneglycol and clinical evaluations.

The aim of the study was to establish a relationship between the clinical efficacy of risperidone (Risp), the biological levels of Risp and its metabolite, 9-hydroxyrisperidone (9-OH-Risp), and the turnover of blood biogenic amines during a long-term treatment (1 year). Risp is one of the newer atypical antipsychotic drugs with potent serotonin (5HT2), moderate D2 and real alpha 1-alpha 2 adrenoreceptor antagonistic effects. The study has been performed in an open setting and included 17 patients, but only 15 were followed-up from 3 to 12 months. Pharmacokinetic analyses were conducted at the same time as clinical evaluations, grading using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI), the Global Assessment of Functioning Scale (GAF), the Quality of Life Scale (QLS) and the Extrapyramidal Symptoms Rating Scale (ESRS) and the determinations of plasma and red blood cell (RBC) Risp and 9-OH-Risp, whole blood 5HT and tryptophan (Trp), plasma homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5HIAA) and dihydroxyphenylethyleneglycol (DHPG). The therapeutic drug monitoring needed oral Risp daily dose of 4.5 +/- 2.3 mg (range 2-8) and the stabilized concentrations (ng/ml) at endpoint in plasma and RBC were 10 +/- 8 (range 1-23) and 3.5 +/- 2 (range 1-8) for Risp and 29 +/- 19 (range 8-70) and 11.5 +/- 6.6 (range 2.6-22.5) for 9-OH-Risp, respectively. 9-OH-Risp appears to be the major active metabolite compound at higher concentrations than Risp. Positive linear correlations were found only between plasma and RBC 9-OH-Risp and the daily dose and the score of the GAF. Statistically significant clinical results showed that Risp is a potent antipsychotic agent efficacious both on positive and negative symptoms and on quality of life. Positive symptoms decreased after about the second month and the negative symptoms improved secondly. Patients (n = 8) who responded to Risp were characterized, on the long-term, by a statistically significant decrease of whole blood 5HT and increase of plasma DHPG.