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Accessible Summary What is known on the subject What the paper adds to existing knowledge What are the implications for practice Introduction Aim Method Results Discussion Implications for Practice People living with schizophrenia spectrum disorder (SSD) have a higher death rate which is caused, in part, by poorer adherence to treatment as compared to those with other mental illnesses. Using long‐acting injectable antipsychotic (LAI) medications can improve medication adherence and reduce hospitalizations for people living with SSD but are often underutilized. As compared to oral antipsychotic medications provided to patients with SSD at discharge from a psychiatric hospitalization, being provided with an LAI antipsychotic medication may reduce subsequent rehospitalization. Specifically, patients discharged on an atypical or second‐generation LAI medication are less likely to be readmitted to the hospital when compared to those discharged on a typical first‐generation oral medication. Because LAI antipsychotic medications are often underutilized as treatment options, the study findings suggest that this modality may be considered for patients with SSD when being discharged from a psychiatric hospitalization. Ideally, psychiatric‐mental health nurses can educate patients about indications, benefits, and risks of using atypical or second‐generation LAI antipsychotic medications during hospitalization and at discharge prevent the risk for future rehospitalizations. People living with schizophrenia spectrum disorder (SSD) have poorer medication adherence compared to those with other mental illnesses. Long‐acting injectable antipsychotic (LAI) medication use is associated with greater adherence, reduced re‐hospitalizations, and improved recovery outcomes when compared to oral formulations.To compare LAI antipsychotic medication use versus oral formulations on readmission to an inpatient hospital.Medical records (N = 707) from a state psychiatric hospital in the southern region of the United States were reviewed. Controlling for demographic variables, logistic regression analyses were used to examine LAI compared to oral formulations on readmission.Compared to patients discharged with oral antipsychotic medications, those with LAIs had a lower proportion of readmission rates in 6‐month and 1‐year periods, but not 30‐day or 2‐year periods. When controlling for demographic variables, those discharged with an atypical LAI had significantly lower odds of being readmitted within the 24‐year period compared to those discharged on a typical oral antipsychotic.Compared to orals, LAIs do not increase and may mitigate readmissions to psychiatric hospitalization.Psychiatric‐mental health nurses and other professionals may recommend LAIs when indicated for those with SSD. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a symposium in South Carolina on the controversies and conundrums in mental health and illness are presented. Topics include cases on criminal responsibility, refusal of medication to avoid execution, and treatment of mental illness by force. The symposium featured the papers from Joseph Bloom, Melissa McDonnell and Robert Phillips, and Howard Zonana.

Abstract: This paper analyzes local and regional geographic variability in the use of antidepressant, antipsychotic and stimulant medications in the United States. Using a data set that covers 60% of prescriptions written in the United States, we find that use of antidepressants in three digit postal codes ranged from less than 1% of residents to more than 40% residents. Stimulant and antipsychotic use exhibited similar levels of local geographic variability. A Kulldorf Spatial Scan identified clusters of elevated use of antidepressants (RR 1.46; p<0.001), antipsychotics (RR 1.42; p<0.001), and stimulants (RR 1.77; p<0.001). Using a multilevel model, we find that access to health care, insurance coverage and pharmaceutical marketing efforts explain much of the geographic variation in use. [Copyright &y& Elsevier]

This paper describes the psychometric properties of two fidelity scales created as part of the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored medication management toolkit and their metric properties when used in 26 public mental health clinics with 50 prescribers. A 23-item scale, based on chart reviews, was developed to assess whether prescribers are following good medication practices, in conjunction with a 17-item scale to assess organizational support for and evaluation of prescriber adherence to recommended medication-related practices. Fundamental gaps in routine practice, including poor documentation of medication history and infrequent monitoring of symptoms and side effects were found. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to review whether the $50m spent by the US National Institute of Mental Health in doing the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trials found any useful evidence to change the clinical management of schizophrenia by psychiatrists. Conclusion: The CATIE trials were conducted in the US on 1460 enrolled patients in an effort to track how the drugs used to treat schizophrenia actually work in clinical practice (rather than in 6-week clinical trials). In a complex 3- phase design, patients were randomized to various types of (mostly) atypical antipsychotic drugs. Some 69-74% of patients switched antipsychotics for one reason or another during the 18 months of treatment. Some of the results were expensive confirmations of known prior results; of the commonly prescribed drugs, clozapine was the most effective, and olanzapine and ziprasidone caused the most and fewest metabolic side effects, respectively. The most stunning finding was that psychiatrists tend to ignore life-threatening, treatable medical conditions in patients presenting for treatment with schizophrenia. Of patients entering the study, 45% had untreated diabetes, 89% had untreated hyperlipidemias and 62% had untreated hypertension. This study failed to reveal anything of significant importance in the psychopharmacological treatment of schizophrenia, but did expose a woeful standard in the medical management of schizophrenia offered by psychiatrists. Psychiatrists should learn to properly treat diabetes, hyperlipidemia and hypertension when detected. [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 author reflects on the paper by Robert A. Rosenheck published within the issue which summarizes the costs of treatment of schizophrenics in the U.S. during the National Institute of Mental Health-sponsored Clinical Antipsychotic Trials of Intervention Effectiveness study. He affirms that Rosenheck's study reassessed the outcome data to assign patients quality-adjusted life year rating. He notes that the study's important aspect is the calculation of lower costs for the drug perphenazine.

Background: Quetiapin is the only antipsychotic approved in the USA as a monotherapy for the treatment of both acute mania and depression associated with bipolar disorder. Objective: The paper''s objective was to research the capabilities of quetiapin in the treatment of a patient with treatment-resistant organic affective disorder. Materials and method: Considering the existence of recommendations for introducing an atypical antipsychotic as a therapy in the treatment of unipolar depression, we will demonstrate our experience in that indication. The subject is a 69 year old patient whose mental disorders appeared for the first time two years ago. The current hospitalization occurred due to depressive and psychotic symptoms and suicidal tendencies. Since the patient had psychomotor inhibition to the point of stupor, and in order to obtain anamnestic data on cognitive disturbances, due to a diagnostic dilemma (dementia or pseudodementia within the affective disorder) the relevant diagnostics were completed: structured psychiatric interview, laboratory tests, internist examination, a brain scan, MMS test, HAM/D17, and CGI/S. Due to a poor response to the therapy and unwanted side effects of the applied drugs, the therapy was modified several times. Quetiapin was introduced to the therapy up to a dose of 400 mg/d. With the introduction of quetiapin there was a reduction in the psychopathology. Improvement was noted in cognitive and work and social functioning. Conclusion: The introduction of quetiapin as a monotherapy turned out to be effective in the treatment of therapy-resistant organic affective disorder, with good tolerability and no side effects. [Copyright &y& Elsevier]