Clozapine v. chlorpromazine in treatment-naive, first-episode schizophrenia: 9-year outcomes of a randomised clinical trial.

BACKGROUND: The differential effects of so-called 'first- and second generation' antipsychotic medications, when given in the first episode, on the long-term outcome of schizophrenia remain to be elucidated. AIMS: We compared the 9-year outcomes of individuals initially randomised to clozapine or chlorpromazine. METHOD: One-hundred and sixty individuals with treatment-naive, first episode schizophrenia or schizophreniform disorder in a mental health centre in Beijing, China were randomised to clozapine or chlorpromazine treatment for up to 2 years,followed by up to an additional 7 years of naturalistic treatment. The primary outcome was remission status for individuals in each group. RESULTS: Individuals in both groups spent essentially equal amounts of time in each clinical state over the follow-up time period(remission, 78%; intermediate, 8%; relapse, 14%). There were no significant differences on other measures of illness severity. The clozapine group was more likely than the chlorpromazine group to remain on the medication to which they were originally assigned (26% v. 10%, P = 0.01). There were no significant differences between the two groups on other secondary efficacy outcomes. CONCLUSIONS: These findings support the comparability in effectiveness between antipsychotic medications but with slightly greater tolerability of clozapine in the treatment of first-episode psychosis.

[A woman's perception of the experience of homebirth assisted by midwife].

The purpose of this study was to understand the essence of midwife care throughout the pregnancy period, ending with the homebirth. Upon learning that the client had given birth at home, the investigator phoned her three months after she had done so. After having explained the purpose of this study, the investigator obtained the client's consent form on arrival at her house. With two 90-minute interviews being conducted, the investigator did not consider the data to be complete until they stopped producing new issues. In accordance with Husserl's phenomenology and the steps of Colaizzi's analysis method, the data's rigor was sustained. Data were classified into four majors themes relating to the client's feelings. These were (1) receiving care in accordance with the woman's wishes, (2) having the right to involve herself in decision making, (3) being supported in her ability to give birth by herself, (4) Strengthening family intimacy. This study shows that homebirth can become a positive experience, only if the pregnant woman has got full support from her family and health professionals before and during the homebirth. It is suggested that homebirth should be encouraged for those women who are healthy and strong enough to undertake it.