Johnson, C.G., Littrell, K.H., & Magill, A.M.H. (1994). Starting Patients On Clozapine in a Partial Hospitalization Program. Hospital and Community Psychiatry 45. (3), 264-268.

This study compared economic and social costs in initiating Clozapine (CLZ) therapy in treatment resistive schizophrenia in a hospital setting to a partial hospital setting. Selected clients had not responded to trials of two standard antipsychotics, had intolerable side effects, and functioned minimally in the community. Diagnostic criteria was Schizophrenia as defined in the Diagnostic and Statistical Manual of Mental Disorders III-R (DSM III-R). Prior history of agranulocytosis or bone marrow abnormality was excluded. Study size was n=47 (m=33 f=14). Suggested reasons for hospitalization were clinician fears of making mistakes, not wanting additional monitoring duties and anticipation of difficulties in clients with a history of non-compliance with medication in tablet form. The researchers note hospitalization is costly, removes the client from their community and reintegration to community is difficult after lengthy hospitalization. In a partial hospital setting, protocols were developed to detect and manage side effects and adverse reactions. Psychoeducational groups focused on the medication, peer support and family education related to the illness, medication and management of side effects. Research suggested partial hospitalization is safe and cost effective as an alternative to hospital. This setting reduced length of stay, interruption of community supports and family links. In a 12 month follow up, clients reported improvement in social functioning, (working, volunteering, returning to school independent living). None required hospitalization during follow up. The partial setting frees beds in hospitals, and reduces cost of CLZ initiation. A well referenced study. Useful for psychiatric nurses, doctors and health educators interested in reducing hospital costs lengths of stay and improvement of quality of life for the treatment resistive schizophrenic.

Holdcroft, C. (1994). Venlafaxine: A New Antidepressant Drug. Nurse Practitioner 19. (9), 21.

The author provides a review of research conducted on the drug Venlafaxine (Effexor). It notes the drug derives its uniqueness from containing similar properties to two other classes of antidepressants, the tricyclics (TCA) and the seritonin reuptake inhibitors (SSRI). In multiple studies, placebo controlled, 68% of a 44-sample size study, patients showed moderate to marked improvement while 31% of placebo patients showed improvement. Another study with 224 patients diagnosed with depression, 90% showed improvement compared to 79% taking Imipramine a TCA. The author reports that Venlafaxine has side effects similar to the SSRI's. Cardiac conduction disturbances and weight gain associated with the TCA class was not noted. This review suggests that this drug appears to be effective treatment for depression. It indicates that more studies are needed before recommending the drug for initial treatment of depression. A cursory review of the drug and easily read. Of interest to psychiatric nurses and patients seeking rudimentary information and knowledge regarding this drug.

Littrell, K., Peabody, C.D. & Littrell, S.H. (1996). Olanzepine: A New Atypical Antipsychotic. Journal of Psychosocial Nursing. 34 (8), 41-46.

This study examined the usefulness of Olanzepine (OLZ) as a first line anti-psychotic agent. It compared OLZ to Haloperidol (HAL) for side effects, adverse reactions, incidence of extrapyramidal effects (EPS) and efficacy of sustained improvement for negative and positive symptoms of schizophrenia, schizoaffective disorder, schizophreniform and substance abuse induced psychosis. The authors note improvements in pharmacotherapy has created a shift in treatment paradigms to improvement of illness instead of stabilization. The study of 3,000 subjects (800 for 6 months or >) were categorized as having an acute exacerbation, residual negative symptoms, affective symptoms, EPS or tardive dyskinesia (TD), intolerance to other anti-psychotics or were newly diagnosed. Subjects were given either a placebo, OLZ-L (2.5, 5 or 7.5mg/day), OLZ-M (7.5, 10 or 12.5mg/day), OLZ-H (12.5 15 or 17.5mg/day) or HAL (10, 15 or 20mg/day). Symptoms were measured using the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Symptom Scale (PANSS) and side effects were measured with Abnormal Involuntary Movement Scale (AIMS) and the Simpson-Angus scale for EPS. The authors note OLZ demonstrated a favourable side effects profile, improvement in the BPRS (negative and positive symptoms) and PANSS ratings over those receiving the placebo and HAL. They contend this improvement focuses psychiatric nursing interventions towards reintegration of clients to community instead of symptom management. A large sample study well referenced and easily read. Useful for psychiatric nurses interested in the transition of clients from institutions to community and how pharmacology can impact that transition and reshape psychiatric nursing interventions.

Littrell, K. and Schultz, R. E. (1994). Resperidone: Clinical Issues in Treatment. Journal of Psychosocial Nursing 32. (5), 47-49.

The article notes pharmacology in schizophrenia has been static since the introduction of Haloperidol (HAL) two decades ago. The authors note that conventional antipsychotics while effective against the positive symptoms have little effect on the negative symptoms of schizophrenia. Side effect profiles of conventional drugs include akathisia, dystonia, parkinsonism and tardive dyskinesia. These affects are believed to be a major factor in medication non-compliance and relapse in chronic schizophrenia. The authors cite four studies, three placebo controlled, using Resperidone with patients experiencing acute exacerbation of symptoms, long term tolerance and efficacy and length of hospital stay when compared to HAL. For exacerbation of symptoms using 36 patients with symptom reduction measured using the Brief Psychiatric Rating Scale (BPRS), Resperidone showed significantly higher scores than HAL and placebo and did not produce higher EPS in comparison to the placebo. A larger study of 523 patients using similar methods found Resperidone had a higher impact on both the positive and negative symptoms and producing a favourable side effects panel to HAL and placebo. Long term efficacy was established in a multi-center study of 264 patients. BPRS ratings after 12 months were reduced by 40%. 5% of participants discontinued therapy due to side effects. An open trial indicated that the mean number of hospital days was reduced by 75% (49 to 13 days) in a group of patients that had spent as much as 165 days in hospital before receiving Resperidone. The article suggests Resperidone has demonstrated to be safe and effective with significant amelioration of positive and negative symptoms with minimal EPS when compared to a conventional antipsychotic. The article is succinct, easily read and understood. Of interest to all seeking understanding of a new pharmacological approach to treating schizophrenia with an interest in alleviating both positive and negative symptoms.

Holdcroft, C. (1993). Paroxetine: A New Selective Serotonin Uptake Inhibitor for Depression. Nurse Practitioner 18. (9), 21.

The article discusses Paroxetine (Paxil) a selective serotonin reuptake inhibitor (SSRI) part of a new class of antidepressants that includes fluoxetine and sertraline. The author reports that deficits of serotonin dopamine and norepinephrine neurotransmitters are thought to be involved in causing depression. Paroxetine has been shown to increase serotonin while having little effect on dopamine and norepinephrine. The article cites a 6-week double blind study using 645 patients indicated that Paroxetine was as effective as Imipramine in treating depression. A second study of 78 outpatients found Paroxetine as effective as fluoxetine. The author notes that caution must be exercised in prescribing this drug to clients using phenytoin and digoxin due to decreased availability of the drugs with concomitant use of Paroxetine. Other reactions have been noted with increased bleeding times in patients taking warfarin. A simplistic article providing little technical information and indicating that it is as effective as a tricyclic antidepressant (Imipramine) but not proven to be superior in efficacy or side effects profile. This article is of interest to all seeking information for determining the efficacy of this new SSRI when compared to traditional tricyclic antidepressants.

Reference

Holdcroft, C. (1994). Venlafaxine: a new antidepressant drug. Nurse Practitioner 19. (9), 21.

Holdcroft, C. (1993). Paroxetine: a new selective serotonin uptake inhibitor for depression. Nurse Practitioner 18. (9), 21.

Johnson, C.G., Littrell, K.H. & Magill, A.M.H. (1994). Starting patients on clozapine in a partial hospitalization program. Hospital and Community Psychiatry 45. (3), 264-268.

Littrell, K., Peabody, C.D. & Littrell, S.H. (1996). Olazepine: A new atypical antipsychotic. Journal of Psychosocial Nursing 34. (8), 41-46.

Littrell, K. and Shultz, R.E. (1994). Resperidone: Clinical issues in treatment. Journal of Psychosocial Nursing 32. (5), 47-49

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