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Medication noncompliance of schizophrenic outpatients is an important problem in clinical practice, causing relapse and illness deterioration. Because atypical neuroleptics have, in controlled clinical studies, been shown to be better tolerated and accepted by patients, the question is whether switching from conventional to atypical neuroleptics such as amisulpride can increase patient compliance also under conditions of routine care. In a drug utilization observation study 570 schizophrenic outpatients, who had been pretreated with conventional neuroleptics and then been switched for individual clinical reasons to amisulpride, were observed for 3 months. Sociodemographic, illness and treatment related variables (e.g. Positive and Negative Symptom Scale, side effects), patients' subjective attitudes, and premedication and treatment compliance were assessed using standardized instruments. A total of 43.7% were rated as being noncompliant with the premedication, while 85.8% were rated as compliant after being switched to amisulpride, including 82.7% of the former noncompliant patients. Patients who had become compliant showed a signicantly better psychopathological status after 3 months as compared to still noncompliant patients, including a lower rate of inpatient stays. Switching noncompliant patients from conventional to atypical neuroleptics like amisulpride can improve patient compliance and psychopathology under conditions of routine treatment.

Objectives: Amisulpride is an unique neuroleptic drug insofar as it has a dual pharmacodynamic effect. At low doses it blocks selectively presynaptic autoreceptors, and at high doses it blocks postsynaptic D(2)/D(3) receptors. This allows the dosage to be adjusted and the treatment tailored to various clinical situations. It is unknown whether this pharmacological property has any bearing for routine treatment. The questions are: which dosages of amisulpride are chosen by physicians in the treatment of schizophrenic inpatients and does this dosage handling deviate from prescription guidelines?; which factors can explain dosage selection, and what is the treatment outcome with different dosages? The study pertains to drug management and dosage finding as principal factors in explaining positive and negative medication results., Methods: In a drug utilization observation study the prescribing of amisulpride for 811 schizophrenic inpatients from 240 psychiatric hospitals was monitored for 8 weeks. Standardized assessment included dosage, the positive and negative symptom scale (PANSS), the clinical global impression rating (CGI), the patients' subjective reaction to amisulpride, psychosocial functioning, EPS and other adverse events. The mean observation period was 49 days., Results: The mean initial daily dose of amisulpride was 361 mg/day. The mean daily dose at day 56 was on average 550 (SD 266) mg/d, ranging from 100 mg to 1600 mg. 17.9% of patients received a maximum dose up to 399 mg/d, 48.1% between 400 and 799 mg/d, and 25.5% 800 mg/d and higher. Higher doses were preferably prescribed for males, patients with involuntary admission, patients with paranoid schizophrenia with acute exacerbation, high CGI and high PANSS-positive scores. Patients with higher doses of amisulpride at the same time received higher rates of additional other neuroleptic drugs. Higher doses yield better results in very severe cases., Conclusions: Prescribed dosages were in the lower range of what is recommended for acute cases. Dosage was significantly influenced by the severity of the illness. Polypharmacy was the rule rather than the exception. Efficacy rates under conditions of routine care were similar to the results from controlled clinical trials, which speaks for their generalizability. Very severe cases profit from higher doses., (Copyright 2004 John Wiley & Sons, Ltd.)

Background. The Positive and Negative Syndrome Scale (PANSS) can be called the standard for the assessment of schizophrenic disorders. It is well-known and routinely used. In scientific studies and clinical practice extensive training of raters in the use of the scale can often not be provided. The question is whether under such conditions psychometric properties of the scale can be guaranteed. Method. In a 2-year drug utilization study on risperidone, 1895 schizophrenic outpatients were assessed by their treating psychiatrists, who were working under conditions of routine care, using a modified version of the Positive and Negative Symptom Scale (PANSS/m). Physicians could not be trained in the use of the scale. The results of these ratings were analysed, comparing means and internal consistency with the original Kay et al. results (Kay et al. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261), and by factor analysis for the total sample and split halves. Results. Means for the positive subscale were similar (6.5 and 6.4, respectively) and means for the negative subscale (11.9 and 8.0, respectively) slightly higher than the original Kay et al. results. Internal consistency of the positive and negative subscales (0.80 and 0.87, and 0.73 and 0.83, respectively) were similar to Kay et al. The same clear factorial solution was found for the total sample and the subsamples. Discussion. Scores for the subscales reflect the predominance of negative symptoms in schizophrenic outpatients. The factorial solution supports the positive and negative subscales of the PANSS. The PANSS/m was easy to use under conditions of routine treatment and is a good and robust scale. [ABSTRACT FROM AUTHOR]