Mirtazapine add-on therapy in the treatment of schizophrenia with atypical antipsychotics: a double-blind, randomised, placebo-controlled clinical trial.

OBJECTIVE: Schizophrenia is a multifaceted illness with positive, negative and cognitive symptom domains. Standard treatments often focus on positive symptoms and may not adequately relieve other symptoms. Previous studies have suggested a role for mirtazapine in schizophrenia, particularly in negative symptoms. This study investigates the efficacy of adding mirtazapine to treatment as usual to alleviate the negative symptoms of schizophrenia. METHODS: In a 6 week, double-blind clinical trial, participants with a diagnosis of schizophrenia and currently being treated with atypical antipsychotic medication were randomised to adjunctive treatment with mirtazapine (30 mg/day) or placebo. The primary outcome measure was improvement in the Positive and Negative Syndrome Scale (PANSS). Measures of cognition, collected at baseline and week 6 only, were analysed using an Analysis of Covariance (ANCOVA) model. All other outcome measures were analysed using a linear mixed model. RESULTS: Forty participants were recruited to the study with equal numbers randomised to each treatment arm. There was no significant difference between mirtazapine and placebo treated participants for improvement in PANSS scores or any of the secondary outcome measures at any stage during the 6-week trial. CONCLUSIONS: This trial does not confirm previous research supporting the use of mirtazapine adjunctive to atypical antipsychotic treatment for schizophrenia.

The patient's voice in a problem-based learning case.

OBJECTIVE: Problem-based learning (PBL) relies upon trigger material, often a paper case, to stimulate self-directed enquiry and group discussion. We describe the process of writing a PBL case based upon a patient's narrative account of her experiences of psychiatric illness, and the possible benefits of that collaboration for the patient, as well as for student learning. CONCLUSION: Real patients are under-utilized in teaching, as are their narratives, and both are believed to be resources worthy of further attention.

Introducing psychosocial and psychiatric concepts to first year medical students using an integrated, biopsychosocial framework.

OBJECTIVE: The main objective of the problem-based teaching unit reported in this paper was to introduce psychosocial and psychiatric concepts to first year medical students using an integrated approach. METHOD: A total of 131 undergraduate students studied a case of delirium. Students were encouraged to understand the problem from a number of perspectives and approaches. In particular, the patient's view was emphasised. This was partially achieved by employing a standardised patient, who answered students' questions about what it was like to be unwell and hospitalised. Both quantitative and qualitative evaluations of the teaching project were conducted. RESULTS: Overall, the teaching project was well received. However, as an introduction to a complex and unfamiliar area, students were concerned that material was difficult to grasp. CONCLUSIONS: As a foundation for future teaching in psychiatry, the case and our methods appear appropriate. However, this initial teaching should be reinforced and expanded upon in all years of the medical curriculum.