Effects of an integrated care program for outpatients with affective or psychotic disorders.

For many psychiatric conditions outcomes of standard care still fall short of outcomes that are possible according to research literature. One of the major reasons is patient׳s non-adherence to long-term medication. We performed a mirror image interventional study involving patients suffering from affective (N=219) or psychotic disorders (N=210) who participated in an integrated care program focusing on treatment adherence. The main outcome variable was the number of inpatients days during the integrated care program compared to the time before the program. The integrated care project studied showed a drop of inpatient days of approx. 75% within the 18-months observation period for both groups. In the affective (psychotic) sample inpatients days dropped from M=47.1 days (M=62.2 days) in the 18 months before the program to M=10.8 days (M=15.3 days) during the adherence program. Patients with affective disorders additionally profited with regard to symptom reduction, quality of life and self-reported adherence. Thus, a complex intervention addressing frequent weaknesses of routine psychiatric outpatient care and focussing on adherence and linking up outpatient services is effective with regard to the reduction of inpatient days for patients with affective and patients with schizophrenic disorders.

Efficacy of flupentixol and risperidone in chronic schizophrenia with predominantly negative symptoms.

The study investigated the non-inferiority of flupentixol compared to risperidone in the treatment of negative symptoms. In addition, the effects of flupentixol on mood and cognitive symptoms were explored. In a randomized, double-blind multicenter study, 144 non-acute schizophrenia patients with predominant negative symptoms were treated with a flexible dose of either flupentixol (4-12 mg/d) or risperidone (2-6 mg/d) for up to 25 weeks. In addition to a non-inferiority analysis, a principal component analysis (PCA) of the PANSS was performed post hoc. Regarding negative symptoms, flupentixol proved to be non-inferior to risperidone. Both drugs improved depressed mood with effect sizes favoring flupentixol. PCA suggested a five-factor structure. Effect sizes for the cognitive factor were up to 0.74 for flupentixol and up to 0.80 for risperidone. EPS scores were rather low and Parkinsonism improved in both groups, but anticholinergic drugs were prescribed significantly more frequently in the flupentixol group, which generally showed significantly more adverse events. Results indicate that the 1st generation antipsychotic flupentixol improves negative, affective and cognitive symptoms in chronic schizophrenia comparable to risperidone. Further studies should confirm the latter using neuropsychological performance tests and should investigate whether tolerability improves with a markedly lower dose range.