Patients' acceptance of the deltoid application of risperidone long-acting injection.

OBJECTIVE: Recently risperidone long-acting injection (RLAI) was approved for alternative injection into the deltoid muscle in addition to the already established injection into the gluteal muscle. For the first time two different injection locations of a long-acting antipsychotic injection can be offered to patients. Their actual acceptance is of key interest. EXPERIMENTAL PROCEDURES: We surveyed 60 patients stabilized on gluteal RLAI therapy in our depot outpatient clinic. Participants were offered the possibility of switching to the alternative deltoid injection in a standardized manner. Prior to switching patients scored the extent of perceived pain and experienced level of shame through the present gluteal injection therapy on a 7-point-scale. Patients choosing to switch were followed up after three months and asked to report on their individual experience. RESULTS: Switching to the deltoid application was chosen by 34 out of 60 patients. Three months later 15 patients were still receiving deltoid injections. The main reason for their staying with the deltoid injection was improved practicability as reported by these patients and 13 out of 15 patients clearly preferred the new location over the gluteal application. The main reason for returning to the gluteal injection was the pain experienced through the injection in the deltoid. Patients' initial decision whether to switch was not correlated with either perceived pain or the experienced level of shame through the preceding gluteal injections. CONCLUSIONS: The application of RLAI in the deltoid muscle is viewed as an alternative to the injection in the gluteal muscle by a considerable number of patients. Nevertheless, some patients experience increased injection pain through this application location while others perceive the switch as beneficial in terms of practicability. Therefore offering both injection locations with their respective pros and cons should become standard in the RLAI treatment offered.

Environmental risk factors and their impact on the age of onset of schizophrenia: Comparing familial to non-familial schizophrenia.

BACKGROUND AND AIMS: Several risk factors for schizophrenia have yet been identified. The aim of our study was to investigate how certain childhood and adolescent risk factors predict the age of onset of psychosis in patients with and without a familial component (i.e. a relative with schizophrenia or schizoaffective disorder). METHODS: Aside from the age of onset of psychosis, we examined the risk factors for schizophrenia including obstetric complications, birth during winter or spring, behavioral deviances or delayed motor and speech development, exposure to adverse life events and exposure to substance use within a group of 100 patients (45 female, 55 male) with a mean age (± standard deviation) of 35.15 ± 13.21. RESULTS: Birth complications and cannabis abuse are predictors for an earlier onset of schizophrenia in patients with non-familial schizophrenia. No environmental risk factors for an earlier age of onset in familial schizophrenia have been identified. CONCLUSIONS: Certain environmental risk factors for schizophrenia seem to have an impact on the age of onset of psychosis in non-familial schizophrenia, they do not seem to have an impact on familial schizophrenia.

The role of encoding strategies in the verbal memory performance in patients with schizophrenia.

BACKGROUND. Verbal learning and memory is often compromised in patients with schizophrenia who prefer encoding words in order of their presentation (serial clustering) rather than using semantic categories (semantic clustering). METHOD. One hundred and four in-patients with schizophrenia were assessed twice with the California Verbal Learning Test. RESULTS. Patients showed significantly less semantic than serial clustering at both assessment times. Usage of encoding strategies were not stable over time. An increase in semantic clustering improved recall and recognition performance. CONCLUSIONS. Patients with schizophrenia should be taught to use the more effective encoding strategy of semantic clustering in order to improve their memory performance.

[Wellness-activities to prevent metabolic syndrome among patients with schizophrenia]. / Wellness-orientierte Massnahmen zur Prophylaxe metabolischer Störungen bei schizophren erkrankten Patienten.

OBJECTIVE: Weight gain and metabolic disturbances are growing side effects of a modern antipsychotic therapy. Different programs were developed to reduce them. This article gives an overview of existing and evaluated programs. METHODS: A literature research was made through PubMed. Relevant reviews and intervention studies were identified. RESULTS: Studies with the main outcome variable of weight reductions are numerous, even randomised controlled trials. Short-term weight loss under antipsychotic treatment is possible, but there is still a lack of long-term studies. Life style interventions, which include e. g. physical exercise, are not that common. Also, interventions such as wellness-activities, which contribute by means of adequate motivation strategies to an enhancement of the general well-being, are still missing. Present results turned out to be positive. CONCLUSIONS: Further programs which exceed weight management are required. There is necessity for more studies with consistent outcome variables and methods, especially long-term programs.

[Lack of insight into illness of schizophrenia patients from their relatives' perspective]. / Mangelnde Krankheitseinsicht bei Patienten mit einer schizophrenen Psychose aus der Perspektive der Angehörigen.

OBJECTIVE: Lack of insight into illness of patients with schizophrenia is often a big problem for relatives. Therefore, information was collected on how relatives assess the patients' insight into illness and their current treatment situation. This assessment was compared with the relatives' feelings of well-being. METHODS: Questionnaire-assisted exploration of 84 relatives, who participated in an information session about lack of insight into illness. RESULTS: 73 % of patients had a lack of insight into illness according to their relatives. Of these, 79 % were male, the mean duration of inpatient treatment was 12 months, 56 % used an antipsychotic medication and 80 % were "quite/very ill". Of the patients with insight into illness, 45 % were male (p < 0.01), the duration of inpatient treatment was significantly longer (29 months; p < 0.05), 86 % used antipsychotics (p < 0.05) and only 42 % were judged as "quite/very ill" (p < 0.01). Only 49 % of relatives from the first group, but 67 % of relatives from the second group described their feelings of well-being as "very good / good" (p < 0.05). CONCLUSIONS: The lack of insight into illness requires greater scientific attention in order to develop better treatment options along with greater relief for relatives.

Do individuals with schizophrenia and a borderline intellectual disability benefit from psychoeducational groups?

Studies on psychoeducation in schizophrenia demonstrate significant effects on rehospitalization rates, compliance and knowledge. Within the framework of the Munich COGPIP study we examined whether borderline intellectual disability in patients with schizophrenia limits the benefit from psychoeducational groups. A total of 116 inpatients with schizophrenic or schizoaffective disorders were recruited for the COGPIP study. A manualized, interactive psychoeducational programme of eight sessions (4 weeks) was initiated. Measures of knowledge, adherence and the concept of illness were completed before and after the groups. The short-term outcome of 22 participants with schizophrenia and borderline intellectual disability (IQ 70-85) was compared with the outcome of 75 participants with schizophrenia and IQ > 85. Results showed that individuals with schizophrenia and borderline intellectual disability could be successfully integrated into general psychoeducational groups. The conclusion is that borderline intellectual disability should not be an exclusion criterion for participation in such groups.

Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families.

Psychoeducation was originally conceived as a composite of numerous therapeutic elements within a complex family therapy intervention. Patients and their relatives were, by means of preliminary briefing concerning the illness, supposed to develop a fundamental understanding of the therapy and further be convinced to commit to more long-term involvement. Since the mid 1980s, psychoeducation in German-speaking countries has evolved into an independent therapeutic program with a focus on the didactically skillful communication of key information within the framework of a cognitive-behavioral approach. Through this, patients and their relatives should be empowered to understand and accept the illness and cope with it in a successful manner. Achievement of this basic-level competency is considered to constitute an "obligatory-exercise" program upon which additional "voluntary-exercise" programs such as individual behavioral therapy, self-assertiveness training, problem-solving training, communication training, and further family therapy interventions can be built. Psychoeducation looks to combine the factor of empowerment of the affected with scientifically founded treatment expertise in as efficient a manner as possible. A randomized multicenter study based in Munich showed that within a 2-year period such a program was related to a significant reduction in rehospitalization rates from 58% to 41% and also a shortening of intermittent days spent in hospital from 78 to 39 days. Psychoeducation, in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families.