Search

Aims: This paper estimates the rate of change in primary care prescribing of atypical antipsychotics in the treatment of schizophrenia and schizoaffective disorder and assesses the link between these changes and the individual characteristics of patients. Methods: Analyses use the UK-based General Practice Research Database for the years 1993 to 1999. Data were linked across years for each individual. A panel logistic regression model was used to identify factors influencing the choice between typical and atypical antipsychotics. Results: A total of 4,391 people were included in the dataset. Atypical antipsychotics prescribing in general practice grew from 1.8% in 1993 to 20.8% in 1999. Older patients were less likely to be prescribed an atypical as compared to a typical antipsychotic. Patients who had an inpatient stay in the previous year were over 1.5 times as likely to receive atypical antipsychotics, as were patients who had visited their GP six or more times in the previous year. Conclusions: Empirical results suggest that, over time, factors other than those warranted by the needs of patients may influence the class of antipsychotic they are prescribed. As prescribing of atypical antipsychotics increases, more evidence is needed to determine what factors are impacting upon the choice of antipsychotic medication. Declaration of interest: None. [ABSTRACT FROM AUTHOR]

Clinical trials for the treatment of schizophrenia now often include cognitive assessments in addition to clinical ratings of symptoms. Recently, these trials have included cross-national assessments. It is not clear if translated psychological tests produce consistent results across different languages. This paper presents the results of a study of the comparability of the results of cognitive assessments in different English-speaking countries and a number of countries where tests were translated into other languages. Performance on tests of executive functioning, verbal and visuo-spatial learning and memory, language skills, psychomotor speed, and vigilance was compared across the first episode patients with schizophrenia (n=301) assessed in six different languages (English, French, Finnish, German, Hebrew, and Afrikaans), including two different countries where patients were assessed in English and other languages: Canada (French) and South Africa (Afrikaans). The variance in performance across the sites tested in English was as large as the variance between English and non-English speakers when all tests were considered. Performance differences across English and other languages were found only for executive functions, vigilance, and psychomotor speed, with executive functioning differences nonsignificant when education was considered. No differences were found between English and non-English speakers in Canada. These results suggest that the translation of tests of memory and verbal skills can lead to consistent results across translated versions of the tests. Differences between countries were greater than differences between languages, suggesting the need to consider representativeness of patient samples in terms of local educational attainment. In general, these data support the validity of cross-national neuropsychological assessments. [Copyright &y& Elsevier]

The movement of care into the community for the mentally ill with severe and enduring problems has important implications for primary care services. This paper reports the findings from an interview with practice nurses working in south-west London, United Kingdom, who had participated in a randomised control trial to investigate the effectiveness of training and structured assessment on clinical and social outcomes of patients receiving maintenance medication of depot antipsychotics. The aim of the interview was to explore current practice, attitudes, confidence and priorities for training in relation to these patients. Thirty-nine nurses were interviewed. The majority of practice nurses received scant referral information and worked without protocols. Even though these nurses had received the training, and as a result of the study had increased awareness of the problems of the severely mentally ill, there was a significant relationship between inadequate knowledge of schizophrenia to carry out the task of medication management and lack of confidence. Although the small size of the sample does not permit generalization, important questions are raised for further practice development and research, including the future training needs of practice nurses and partnership relationships with mental health professionals for supervision and support. [ABSTRACT FROM AUTHOR]