Which (if any) drugs should we use for agitated or aggressive behaviour in dementia?

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This is a dilemma I frequently face when I am called out to see someone with dementia on the ward or living in a nursing home. On the one hand I am thinking that anything I use can potentially have serious side-effects and will probably lead to increased health risks and increased mortality. On the [read the full story…]

A new model for schizophrenia?

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Schizophrenia is a complex disorder (or, more likely, group of disorders) that has reality distortion at its core. Efforts to establish the cause of schizophrenia have been ongoing for more than a century, and many models have come and gone in that time (not for nothing has schizophrenia been called ‘the graveyard of neuropathologists’ (Plum, [read the full story…]

Spoilt for choice? Four new Cochrane reviews on antipsychotics for schizophrenia

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Schizophrenia is a crippling condition characterised by psychotic experiences such as delusions and hallucinations. It can be hugely debilitating for the patient and their family and it can also be an enormous challenge for psychiatrists and other health and social care professionals who are responsible for providing care and support to the service user. Currently, [read the full story…]

Drug treatment of refractory schizophrenia remains a major challenge, but clozapine continues to be gold standard

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Schizophrenia is a crippling condition that often (in about 20-30% of patients) shows an inadequate response to first-line antipsychotic drugs. Because it is associated with significant, often devastating reductions in quality of life, the management of refractory cases of schizophrenia represents a major challenge to psychiatry. As pharmacotherapy is the treatment of choice, stringent guidelines [read the full story…]

New study demonstrates effectiveness of antipsychotic Pimavanserin for Parkinson’s disease psychosis

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When we think of Parkinson’s disease (PD), hallucinations and delusions are probably not the first symptoms that come to mind. And yet, it is estimated that nearly half of all patients with PD experience psychotic symptoms at one time or another. Although deficits in motor function are seen as the hallmark of PD, it is [read the full story…]

Psychosis and schizophrenia in adults: updated NICE guidance for 2014

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While the organisation’s name may change frequently, currently National Institute for Health and Care Excellence (NICE), its role remains constant – to provide clear published guidance on the role of treatment options within the NHS. The publication of new NICE guidance represents a significant event as clinical recommendations shape the nature of provided care nationally [read the full story…]

Pilot study suggests that CBT may be a viable alternative to antipsychotics for people with schizophrenia, or does it?

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People with schizophrenia stop taking their antipsychotics for a wide range of reasons (e.g. debilitating side effects or a belief that they will not help them), but when they do health professionals often find it extremely difficult to care for these patients, because the alternative treatment options available to them are very limited. Of course, [read the full story…]

Cochrane review finds that haloperidol is an effective antipsychotic, but its side effects can be problematic

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Schizophrenia is a serious disorder characterised by delusions (including paranoid beliefs and hallucinations) and other symptoms such as blunted affect and reduced motivation. While relatively uncommon (lifetime prevalence is less than 1%), it is associated with serious social impairment (e.g., unemployment, homelessness), which in turn can result in physical health problems. As a result, the [read the full story…]

Long term maintenance treatment with antipsychotics: a cautionary note from recent research

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The support of individuals with experience of psychosis is complex and relies on a combination of psychopharmacology (antipsychotic drugs), psychological therapies and social interventions. Antipsychotics will often be the first line treatment offered, with the intention of reducing psychotic symptom burden. Following the resolution of immediate symptoms the role of antipsychotics becomes less clear; should [read the full story…]

Atypical antipsychotics no better than typicals for adolescents with psychosis, but atypicals may have fewer short-term side effects

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Schizophrenia is a serious neurodevelopmental disorder that often starts during adolescence. Current treatment guidelines (NICE, 2013) recommend atypical antipsychotics for adolescents with this condition, but this is based largely on studies of adults with the condition. The Cochrane Schizophrenia Group conducted this systematic review to synthesise the current evidence base for atypical antipsychotic medication in [read the full story…]