Optimized Use of Atypical Antipsychotics Associated With Equal Efficacy and Brief Hospital Stays in Patients With Acute Psychosis

Optimized Use of Atypical Antipsychotics Associated With Equal Efficacy and Brief Hospital Stays in Patients With Acute Psychosis

June 14, 2006

    MELBOURNE, June 14 /Xinhua-PRNewswire/ -- A new study
published by physicians from the Mental Health Research
Institute and Monash University of Victoria, Australia,
showed that all atypical antipsychotics studied were
equally efficacious when used at optimal doses as primary
medication for inpatients with acute psychosis.(1) They
were associated with remarkably brief hospital stays. This
hospital-based study adds to the clinical evidence
regarding patient response patterns to the best treatment
approaches of acute psychosis in real-life clinical
practice.

    The study published in the International Journal of
Psychiatry in Clinical Practice also found that patients
treated with the atypical antipsychotics quetiapine,
risperidone or olanzapine as primary treatment, in addition
to adjunctive medications, showed a similar time to efficacy
(mean time to efficacy was 11.2, 10.2 and 11.2 days,
respectively).(1) The mean doses of atypical antipsychotics
used were 567 mg quetiapine, 4.1 mg risperidone or 22.5 mg
olanzapine.

    Overall, hospital stays for these patients were
remarkably brief despite their initial severe
psychopathological disturbances. Patients treated with
quetiapine, risperidone and olanzapine were discharged from
hospital in just over two weeks (means of 17.0, 16.7 and
15.8 days, respectively). All medication schedules were
associated with good tolerability and no serious side
effects were seen. Patients receiving quetiapine required
significantly less benzodiazepines as co-medication
compared to patients receiving risperidone or olanzapine.

    Lead investigator Professor Nicholas Keks, Mental
Health Hospital Research Institute of Victoria, Australia,
commented: "Acute psychosis is a severe mental
condition that greatly disturbs the life of affected
individuals and their families. The most important aim of
therapy is to alleviate symptoms rapidly and, using
medication optimally, to facilitate return to community
care. The atypical antipsychotics studied clearly help to
achieve a return to normal life for these patients."

    This study also examined a more rapid titration
schedule of the atypical antipsychotic quetiapine (n = 32)
than the current approved prescribing information. Most
patients responded well to the accelerated titration, which
started at 150-400 mg of quetiapine on day one and increased
to higher doses in the course of treatment.

    Prof Keks added: "Clinical guidelines are very
important. However, it is even more important to fine-tune
the therapy approach to the individual to achieve the
optimal treatment outcome, especially in acute psychosis.
Some patients seem to respond well to higher doses of
atypicals or faster titration of quetiapine although larger
studies are necessary to support our findings."

    Acute mental illness causes a significant strain on the
healthcare and societal resources. Acute psychosis can
appear suddenly in untreated individuals with
schizophrenia, or schizophrenia-spectrum disorders, but
also people suffering from bipolar disorder or major
depression. It is estimated that approximately one percent
of the population are affected by schizophrenia,(2) four
percent by schizophrenia-spectrum disorders,(3) three to
four percent by bipolar disorder(4) and six percent by
major depression(5).

    The retrospective, naturalistic study conducted by
Professor Nicholas Keks and colleagues over a period of 12
months at Box Hill Hospital acute psychiatric care unit
during 2001 included 137 inpatients who were prescribed
atypical antipsychotics as first-line treatment for their
acute psychosis. In total, 37 patients received quetiapine,
38 risperidone and 56 olanzapine in addition to other
medications. Treatment protocols were developed from
published guidelines.

    The study was funded by the Mental Health Research
Institute of Victoria.

    References:

    1) Keks N, Tonso M, Tabone K, et al. Clinical
experience with atypical 
       antipsychotics in an acute inpatient unit: focus on
quetiapine. Int J 
       Psychiatry Clin Practice 2006;10(2):138-41.

    2) Suppina AL, Patten SB. Self-reported diagnoses of
schizophrenia and 
       psychotic disorders may be valuable for monitoring
and surveillance. 
       Can J Psychiatry 2006;51(4):256-9.

    3) Mattia JI, Zimmerman M. Epidemiology. In Livesley
WJ, ed. The handbook 
       of personality disorders. New York, NY: The Guilford
Press, 2001;
       107-23.

    4) Hirschfeld RMA, Calabrese JR, Weissman MM, et al.
Screening for bipolar 
       disorder in the community. J Clin Psychiatry
2003;64:53-9.

    5) Wittchen ES, Jacobi F. Size and burden of mental
disorders in Europe - 
       a critical review and appraisal of 27 studies. Eur 
       Neuropsychopharmacology 2005;15:357-76.

    For more informatioin, please contact:

     Professor Nicholas Keks
     Tel:   [phone]
     
     Mr Ross Johnson
     Media Communications Office
     Tel:   [phone]

SOURCE  Mental Health Research Institute and Monash
University