Associations Between Adherence to Guidelines for Antipsychotic Dose and Health Status, Side Effects, and Patient Care Experiences

Dickey, Barbara; Normand, Sharon‐Lise T.; Eisen, Sue; Hermann, Richard C.; Cleary, Paul D.; Cortés, Dharma E.; Ware, Norma C.

doi:10.1097/01.mlr.0000215806.11805.6c

Cited by 22 publications

(17 citation statements)

References 18 publications

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“…The benefit of increasing doses is uncertain; for example, studies that have compared doses higher than 2000 mg of chlorpromazine per day with lower doses have demonstrated superior efficacy for high-dose treatment (Quitkin, Rifkin, & Klein, 1975;Ericksen et al, 1978;McCreadie & MacDonald, 1977) while high doses of haloperidol have not proved to be more effective (Van Putten et al, 1992). Dickey et al (2006) examined the relationship between evidencebased antipsychotic medication dose and health status, perceptions of care, and medication side effects among the acutely ill, high-risk patients with schizophrenia. They found that higher than recommended doses were not related to better outcomes.…”

Section: Dosing In Schizophreniamentioning

confidence: 99%

Are we using excessive neuroleptics? An argument for systematic neuroleptic dose reduction in stable patients with schizophrenia with specific reference to clozapine

Yamin

Vaddadi

2010

International Review of Psychiatry

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Pharmacological intervention using antipsychotic agents is the cornerstone of treatment in schizophrenia. Polypharmacy and the use of higher doses is often practised in the hope of getting better symptom control in multi-episode, chronically unwell, people with schizophrenia. However, these regimes often pose unacceptable and at times dangerous risks. The current review examines the factors that influence dosing and argues that optimization is transient and needs ongoing consideration throughout the course of the illness. What is defined as 'the optimal dose' changes over the course of the illness and this should be reflected in treatment. The evidence presented in the current paper suggests that given the negative symptoms associated with neuroleptic medication, dosage should be discussed as part of the case review process and dosage should be systematically reduced as part of the standard treatment protocol. A case-study is presented of a patient who had her dosage of clozapine reduced and the subsequent health and lifestyle benefits from this reduction. We argue that the focus needs to be shifted away from the specific aim of treatment of psychotic symptoms to a more holistic view of treatment that incorporates function and psychosocial function as a measure of improvement.

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Section: Dosing In Schizophreniamentioning

confidence: 99%

Are we using excessive neuroleptics? An argument for systematic neuroleptic dose reduction in stable patients with schizophrenia with specific reference to clozapine

Yamin

Vaddadi

2010

International Review of Psychiatry

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“…In a previous Medicaid database study, Dickey et al (Dickey et al, 2006) found adherence to the 1998 Schizophrenia PORT antipsychotic dosage recommendations were generally unrelated to measures of health status. Physical health was better, but not significantly, in the group whose dose was within the guideline recommendations.…”

Section: Discussionmentioning

confidence: 97%

Community Adherence to Schizophrenia Treatment and Safety Monitoring Guidelines

Keller¹,

Fischer²,

McMahon³

et al. 2014

Journal of Nervous &Amp; Mental Disease

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The 2003 Schizophrenia PORT treatment recommendations and Mt. Sinai Conference Safety Monitoring recommendations generated guidelines for pharmacological treatment of schizophrenia and monitoring of antipsychotic side effects. This study examined rate of recommendation adherence and impact of adherence on outcomes of outpatients with schizophrenia or schizoaffective disorder in community mental health centers. Clinical practice was assessed as conformant, non-conformant, or not applicable. Treatment practices were conformant for antipsychotic dose (83%), use of antiparkinsonian (97%), antidepressant (100%), and antianxiety agents (90%), but not clozapine for residual positive symptoms (31%), monitoring weight gain (48%), glucose dysregulation (53%), hyperlipidemia (34%), or extrapyramidal symptoms (11%). Community mental health center treatment practices were largely conformant with 2003 Schizophrenia PORT treatment recommendations. There is less evidence patients who receive treatment in the community are adequately monitored for antipsychotic side effects per Mt. Sinai recommendations.

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“…In this study schizophrenia-specific positive or negative symptoms related to adherence to specific medications were not measured, mainly because the authors think that patients treated in clinical settings are more diverse than those in clinical trials (Dickey et al 2006). Instead outcomes measures that reflected more general benefits of problem reduction and community functioning such as the rates of patients' physical restraint, in hospital re-admission and job re-insert were used.…”

Section: Discussionmentioning

confidence: 98%

“…According to other studies doctors and nurses experience difficulties in including evidence-based practices within the care pathway, mainly because of divergent views on the nature of standardized care for people with schizophrenia (Jones 2004;Dickey et al 2006). However, this did not affect the care pathway implementation and the results of the study showed significant improvements of the quality of the process of care when compared to the traditional one.…”

Section: Discussionmentioning

confidence: 99%

Effect of Introducing a Care Pathway to Standardize Treatment and Nursing of Schizophrenia

Marchisio

Vanetti

Valsesia

et al. 2009

Community Ment Health J

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Care pathways can help to implement evidence-based clinical practice. The introduction of care pathways is difficult for psychiatric disorders. This study examined whether the organization and the effectiveness of care provided to schizophrenic patients can be improved by care pathways. Outcomes from 19 patients receiving treatment using evidence-based care pathways were compared with 17 patients receiving a traditional approach to care over a 3 months period. Results showed significant improvements in the quality of the care for the patients included in the care pathway group. The authors concluded the positive outcomes for patients treated with care pathways were related to the assistance provided to clinicians in identifying and implementing evidence-based standards.

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Associations Between Adherence to Guidelines for Antipsychotic Dose and Health Status, Side Effects, and Patient Care Experiences

Cited by 22 publications

References 18 publications

Are we using excessive neuroleptics? An argument for systematic neuroleptic dose reduction in stable patients with schizophrenia with specific reference to clozapine

Are we using excessive neuroleptics? An argument for systematic neuroleptic dose reduction in stable patients with schizophrenia with specific reference to clozapine

Community Adherence to Schizophrenia Treatment and Safety Monitoring Guidelines

Effect of Introducing a Care Pathway to Standardize Treatment and Nursing of Schizophrenia

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