ABSTRACT
BACKGROUND: Clozapine is effective in up to 60% of patients with refractory schizophrenia, whereas the efficacy of risperidone remains unknown. This retrospective study examined the relative efficacy of these drugs in chronically institutionalized patients refractory to conventional antipsychotic agents. METHOD: A total of 24 patients who at different time periods had received adequate trials of both clozapine and risperidone and met our inclusion criteria for minimum dose and duration of each trial were included; for clozapine, a minimum dose of 300 mg/day had to be maintained for at least 12 weeks, and for risperidone, a minimum dose of 6 mg/day for at least 6 weeks. Information obtained from systematic retrospective chart review was blindly rated by 2 psychiatrists using the 7-point Clinical Global Impressions-Improvement (CGI-I) scale on overall clinical state and along specific symptom domains of positive symptoms, negative symptoms, and aggressive behavior. RESULTS: The mean +/- SD dose was 520+/-94 mg/day for clozapine and 7.5+/-2.2 mg/day for risperidone. Fourteen patients (58%) were classified as responders to clozapine, while 6 (25%) responded to risperidone (CGI-I score of 1 or 2); on specific symptom domains, response rates to clozapine were 38% (9/24) on positive symptoms, 29% (7/24) on negative symptoms, and 71% (12/17) on aggressive behavior. For risperidone, response rates were 17% (4/24) on positive symptoms, 8% (2/24) on negative symptoms, and 41% (7/17) on aggressive behavior. CONCLUSION: The results of this study support the utility of first giving a risperidone trial in a treatment algorithm for refractory patients because of its better risk/benefit profile compared with clozapine. Clozapine, however, remains our gold standard in the management of these patients.
Subject(s)
Clozapine/therapeutic use , Psychotic Disorders/drug therapy , Risperidone/therapeutic use , Schizophrenia/drug therapy , Adult , Aggression/psychology , Drug Administration Schedule , Humans , Male , Middle Aged , Psychiatric Status Rating Scales/statistics & numerical data , Retrospective Studies , Schizophrenic Psychology , Treatment OutcomeABSTRACT
The ubiquity of the world-wide web allows unique educational opportunities for continuing medical education (CME). We have designed a comprehensive breast imaging CME curriculum to permit individual physicians in their homes or offices to use personal computers to ease the burden of this process. Category 1 CME credits can be earned off-hours without having the physician travel out of town. In addition, since the course is computer-based, the overall costs to the participant are substantially reduced. The program can be updated on an ongoing basis to include new technology or to provide additional information requested by the users.
Subject(s)
Breast Diseases/diagnosis , Diagnostic Imaging , Education, Medical, Continuing , Internet , Radiology/education , Costs and Cost Analysis , Curriculum , Education, Medical, Continuing/economics , Education, Medical, Continuing/methods , Female , Humans , Microcomputers , Software , Technology, Radiologic/educationABSTRACT
BACKGROUND: Previous factor analytic studies of patients with schizophrenia have consistently demonstrated the presence of 3 psychopathological domains labeled positive, negative, and disorganized. This study examined whether similar domains can be seen in disorders other than schizophrenia, and the degree to which such domains are independent of diagnostic categorization. METHODS: Data from the Diagnostic and Statistical manual of Mental Disorders, Fourth Edition (DSM-IV) field trial involving 221 patients with schizophrenia and 189 patients with nonschizophrenia diagnoses were factor analyzed to study the nature of psychopathological domains in the 2 groups. Differential associations between each domain and selected clinical variables were assessed. RESULTS: Factor analysis yielded a similar 3-factor model of positive, negative, and disorganization domains for patients with schizophrenia as well as other diagnoses. Differential associations found between individual domains and clinical variables (premorbid functioning and negative domain; absence of remissions and disorganization domain) were similar in both schizophrenia and nonschizophrenia groups. CONCLUSIONS: The 3 psychopathological domains previously described in schizophrenia are not specific for that diagnosis. Differential associations found between individual domains and clinical variables were not limited by diagnostic categorization. The results suggest that these domains are not unique to schizophrenia and may each correspond to a discrete pathophysiologic condition.
