The new approach: psychosocial functioning as a necessary outcome criterion for therapeutic success in schizophrenia.
Clinical therapeutics

Current Opinion in Psychiatry. 21(6):630-639, November 2008.
Juckel, Georg a; Morosini, Pier Luigi b

Abstract:
Purpose of review: Although in the past most attention was paid to psychopathology, these days outcome parameters such as cognitive and occupational performance, emotional stability, quality of life and psychosocial functioning are being recognized as important determinants of treatment success. Instead of only reducing the symptoms, therapy with antipsychotics must attain higher goals such as remission and recovery today.

Recent findings: The Psychosocial Performance Scale offers a validated, reliable and operational tool to assess the psychosocial functioning of patients during the course of treatment as well as in the acute state. The Mini-ICF-P might be a similar instrument for measuring psychosocial functioning.

Summary: In the future, medication and non-medication treatment strategies will also be judged by the ability to improve the psychosocial functioning of patients with schizophrenia, as measured by the Personal and Social Performance scale and the Mini-ICF-P.

 

 

 

Transcranial magnetic stimulation.

Clinical therapeutics

Current Opinion in Psychiatry. 21(6):640-644, November 2008.
Lopez-Ibor, Juan J a,b; Lopez-Ibor, Maria-Ines a; Pastrana, Jose I c

Abstract:
Purpose of review: To present state-of-the-art transcranial magnetic stimulation (TMS) therapy, especially when it is used in psychiatric disorders, on the basis of an exhaustive literature search from 2006 to date (June 2008) on TMS papers published in Medline and Embase. Other references and comments from our own experience started 8 years ago have also been taken into account.

Recent findings: The mechanism of action of TMS is now better understood. There is strong evidence of the safety and tolerability of TMS when standard protocols are used. The efficacy of the stimulation of the dorsolateral prefrontal cortex in depression is well documented, and there is evidence of the utility of TMS in posttraumatic stress disorder, in persistent auditory hallucinations in schizophrenia and in attention-deficit disorder with hyperactivity.

Summary: There is enough evidence of the efficacy and safety of TMS in depression to include this technique in the therapeutic protocols of major depression. However, more research is needed on the use of this technique in other psychiatric

 

 

 

Psychotropic prescription practices in east Asia: looking back and peering ahead.

Clinical therapeutics

Current Opinion in Psychiatry. 21(6):645-650, November 2008.
Tan, Chay-Hoon a; Shinfuku, Naotaka b; Sim, Kang c

Abstract:
Purpose of review: The present review focuses on the pharmacoepidemiological issues of psychotropic drug use in countries within east Asia, with special emphasis on antipsychotic, antidepressant and benzodiazepine prescriptions. Pharmacogenetic studies in different ethnic groups are also reviewed.

Recent findings: Recent studies have revealed the prevalence of antipsychotic polytherapy (defined as the use of more than one antipsychotic; up to 45.7%), less conservative antipsychotic use (defined as the use of more than 1000 mg/day chlorpromazine equivalents; up to 17.9%) and depot antipsychotic use (up to 15.3%) in different populations in east Asia. Clozapine is commonly prescribed (up to 60%) in China. There is a trend of increasing second-generation antipsychotic use in east Asian countries. Up to 67.5% of patients received newer antidepressants such as selective serotonin reuptake inhibitors. Benzodiazepine medications are used in up to 29.9% of study populations. Socioeconomic factors appear to be one of the major common factors that affect the prescription of antipsychotics and newer antidepressants. Pharmacogenetic factors associated with antipsychotic response, weight gain and extrapyramidal side effects have been examined. Treatment adherence and pharmacoeconomic factors are relatively understudied.

Summary: Future studies on prescribing trends of antipsychotics and antidepressants need to focus on children, adolescent and elderly patient populations, the impact of changing prescription trends and the long-term effects on patients and their caregivers, as well as pharmacogenetic factors, which can potentially pave the way for better and more individualized prescription of psychotropic drugs in east Asia.