Questionnaire for different clinical scenarios.
- Strategies for switching antipsychotic treatment.
Which of the following better describes your strategy when switching from a typical to an atypical antipsychotic?
a. Stop the typical abruptly and begin the atypical the next day
(23.9%)
b. Stop typical and wait 2 or 3 days before beginning atypical (washout)
(31%)
c. Start patient on atypical while they are still on typical
(45.1%)
If you choose (c), How many days would you overlap?
10.1 +/-12.1( 2-70 )days
If a patient remains actively psychotic after 6 weeks of typical antipsychotic treatment, which of the following would you do?
a)Increase the dosage(20.8%)
b)Give other typical(6.9%)
c)Switch to atypical (63.9%)
d)Continue current antipsychotic(0.7%)
e)Continue current antipsychotic in combination with atypical (7.6%)
Which of the following best describes how you decide to switch from typical to atypical after a patient has shown no improvement in psychosis?
a)After 1 typical for 4 weeks (60.1%)
b)After 2 typicals each for 4 weeks (27.5%)
c)After 3 typicals each for 4 weeks(2.2%)
d)Other (10.1%)
2. Daily dosages used for different clinical conditions
Risperidone(mg/day) / Olanzapine
(mg/day) / Quetiapine
(mg/day) / Clozapine
(mg/day)
Active psychosis / 5.2 (1.8) 1-12 / 11.8 (3.3) 5-20 / 251.1(185.6) 10-800 / 243.1(140.3) 50-700
Refractory psychosis / 6.6 (2.3) 2-18 / 14.6 (6.1) 5-40 / 323.1(185.5) 20-800 / 334.6(179.8) 10-750
Susceptibility for extrapyramidal symptoms / 3 (1.4)
1-9 / 7.9 (3.7) 3-20 / 180.3(157.3) 5-800 / 168.3(113.3) 25-400
Early psychotic episode / 4 (1.7)
1-10 / 8.9 (3.7) 3-30 / 188.4(127.5) 10-400 / 172.2(113.1) 25-400
Psychosis in the elderly / 2.1 (1.1) 1-6 / 5.4 (2.3) 3-15 / 92.8 (68.6) 5-200 / 73.3 (66.1) 25-300
3. Notion of resistant schizophrenia
A treatment refractory patient is one who:
a)Shows no change in severity of psychosis (64.1%)
b)Shows some improvement in severity of psychotic symptoms but still has active psychotic symptoms (55.2%)
c)Has minimal psychotic symptoms but severe anhedonia, social withdrawal and social impairment. (39.3%)
Rafael, a 45 year-old male, was diagnosed schizophrenia since age 25. He spent 15 of the last 25 years as an inpatient. He is currently an inpatient, has no psychotic symptoms, moderate cognitive impairment and negative symptoms and has failed several attempts to enter active rehabilitation. He has been given three different typical antipsychotics.
a)Would you consider him a refractory patient?
Yes(55.6%) No(44.4%)
b)Would you try him on an atypical antipsychotic?
Yes(96.5%)No(3.5%)
c)If one atypical failed would you try a second one?
Yes(93.1%) No(6.9%)
4. Treatment maintenance
Juan, a 19 year-old male, comes to you floridly psychotic for the first time in his life. After drug treatment for three months he no longer shows positive symptoms and has mild improvement in social and occupational functioning.
¿For how long would you continue antipsychotic treatment in this patient?
a)One month(6.8%)
b)2-4 months(15.8%)
c)6-12 months(41.1%)
d)Indefinitely(23.3%)
e)Other(13%)
Pedro, a 19 year-old male with the diagnosis of schizophrenia, has presented several psychotic episodes since his first one, 3 years ago. During the last year and a half he hasn’t presented any psychotic symptoms, but he still presents moderate negative symptoms.
¿For how long would you continue antipsychotic treatment in this patient?
a)One month(4.8%)
b)2-4 months(4.8%)
c)6-12 months(15.2%)
d)Indefinitely(65.5%)
e)Other(9.7%)
5. The most effective atypical antipsychotic for relapse prevention
a)Risperidone:(65.9%)
b)Olanzapine:(24.6%)
c)Quetiapine: (1.4%)
d)Clozapine: (8%)
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