Noncompliance & Treatment-Resistant Schizophrenia
Treatment-Resistant Schizophrenia
By Henry A. Nasrallah, MD & Randall F. White, MD
Published by Medscape
Release Date: May 30, 2006; Valid for CME credit through May 30, 2007
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While Treatment-Resistant Schizophrenia deals with the general phenomenon of treatment-resistance to antipsychotics, which manifests in 20% of schizophrenic patients who, consequently, continue to manifest positive symptoms and formal thought disorder despite being prescribed appropriate courses of medication, noncompliance, as one would suspect, can play a significant role in this problem and is consequently the focus of a significant portion of this article.
In fact, although Nasrallah and White, in keeping with Medscape’s categorization and promotion of this piece as CME, provide a well organized overview of treatment-resistance from its formal definition to pertinent research to tips for clinical management, replete with two case examples, their consideration of noncompliance goes beyond the oversimplified recitation of clinical clichés one often finds in the CME genre.
Especially impressive is the authors’ careful distinction between compliance enhancements that have been shown to be effective and those which appeal to ones logic or intuition but are unproven. They point out, for example, that while side-effects are frequently implicated in noncompliance and, congruently, subjects in clinical trials are more likely to complete a course of treatment on second-generation antipsychotics, which cause fewer side-effects, than those subjects taking medications more likely to cause side-effects, analogous studies of clinical populations show no statistical difference between patients using second-generation agents and first-generation agents.
Commentary
This paper’s treatment of adherence is well-crafted, pragmatically oriented, and nuanced. The intellectual honesty and clarity are particularly refreshing, precisely because these qualities all too often fall victim to either nihilistic despair evoked by the difficulty in dealing with noncompliance or an authorial penchant for evangelism of a preferred tactic rather than a dispassionate examination of the evidence.
Credits Available:
Physicians - up to 1.25 AMA PRA Category 1 Credits for physicians;
Nurses - 1.5 ANCC continuing education contact hours for nurses (0.5 contact hours are in the area of pharmacology)
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