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It is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations.
To examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence.
Analysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study).
Across both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in the patients prescribed an LAI pre-randomisation was ameliorated if they had been randomised to clozapine rather than another SGA. There was no advantage to being randomly assigned from an LAI at baseline to a non-clozapine oral SGA rather than an oral FGA.
A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antipsychotic to another. This effect appears to be moderated by adherence, and may not extend to switching to clozapine. This has implications for clinical trial design: the drug from which a participant is randomised may have a greater effect than the drug to which they are randomised.
In the mid 90s, the combination of Prince Charles' fears about ‘grey goo’ and Michael Crichton's novel The Swarm served to increase fears that nanotechnology would be the latest in a series of late twentieth-century science scares that would hinder if not completely delay development and application of the needed technology. The fact that science communication was still in its infancy and that many of the limited pool of practitioners had been involved in the nuclear and GM debates added to an air of near fatalism. It was feared that only one incident of, for example, toxic nanoparticle release would suffice to push public opinion decisively and irreversibly against the technology. In this chapter, drawing on my experience as a public relations practitioner rather than an academic, I will investigate the reality of the situation and come to the conclusion that this is far too simplistic a view and furthermore, that nanotechnology has had a fairly easy ride in the media and is far from top of the agenda for even specialist journalists. This avoidance of scandal has enabled nanotechnology to put down such strong roots and already deliver such tangible benefits that I believe its future is secure. Any future problems will be viewed by the media on a case-by-case basis and not lead to condemnation of the technology per se. The chapter is based on a series of situation reviews presented by the author to the European Commission-funded NanoBio-RAISE and Nanomed Round Table projects during the 2005–2010 period.
The first issue seems to be that those involved in ‘protecting’ the image of nanotechnology have failed to see the ‘bigger’ picture. Naturally they believe that nanotechnology is one of the main issues in science and thus of major importance to the media. Nothing could be further from the truth. In one of the greatest eras of scientific advance, nanotechnology is competing for ‘share of voice’ with topics such as cloning, the Human Genome Project, HIV research, general medical advances, particle physics and more recently global warming and climate change.
There have been few detailed longitudinal symptom studies of bipolar
To describe the course of bipolar disorder over 18 months in 204 patients
receiving mental healthcare.
Patients were interviewed every 8 weeks, with weekly ratings of
depression, mania and overall severity.
Participants were symptomatic 53% of the time, with sub-syndromal
symptoms present for twice as long as major disorder, and depressive
symptoms three times more than manic symptoms. Individuals who were
experiencing an episode at baseline spent 33% of the 18 months with
substantial sub-syndromal symptoms, 17% with major disorder and 28%
symptom free. Those not experiencing a baseline episode spent twice as
long symptom free and half as long at disorder levels. Changes in symptom
level were frequent. Predictors of sub-syndromal symptoms were similar to
those of major disorder.
Sub-syndromal residual symptoms are an important problem in recurrent
bipolar disorder and require therapeutic intervention.
Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders.
To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT).
We undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months.
More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes.
People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.
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