The Journal of clinical psychiatry
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Multicenter Study Comparative Study Clinical Trial
Reducing violence risk in persons with schizophrenia: olanzapine versus risperidone.
This study prospectively examined the effectiveness of treatment with olanzapine versus risperidone in reducing violent behavior among patients with schizophrenia under "usual care" conditions in the community. ⋯ This study found that, in the complex "real world" settings where persons with schizophrenia reside, long-term treatment with olanzapine confers some advantage over risperidone in reducing violence risk. This advantage appears to be at least in part an indirect effect, via improvement in adherence with treatment. Specifically, adherence with prescribed medication was found to mediate the association between olanzapine treatment and reduced violent behavior.
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Multicenter Study Comparative Study
Clinicians' reasons for antipsychotic coprescribing.
Prescribing more than 1 antipsychotic is common but has received little supportive evidence in the literature. This study was designed to systematically survey clinicians about their rationale for prescribing more than 1 antipsychotic for specific patients. ⋯ Prescribers for patients receiving more than one antipsychotic were frequently able to cite plausible and specific target symptoms they were attempting to address with this practice.
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The physical health of patients with borderline personality disorder has not been well studied. The purpose of this study was to compare the physical health, lifestyle choices affecting physical health, and health care utilization of patients with remitted and nonremitted borderline personality disorder. ⋯ The failure to remit from borderline personality disorder seems to be associated with a heightened risk of suffering from chronic physical conditions, making poor health-related lifestyle choices, and using costly forms of medical services.
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A researcher must carefully balance the risk of 2 undesirable outcomes when designing a clinical trial: false-positive results (type I error) and false-negative results (type II error). In planning the study, careful attention is routinely paid to statistical power (i.e., the complement of type II error) and corresponding sample size requirements. However, Bonferroni-type alpha adjustments to protect against type I error for multiple tests are often resisted. Here, a simple strategy is described that adjusts alpha for multiple primary efficacy measures, yet maintains statistical power for each test. ⋯ The strategy described adjusts alpha for multiple primary efficacy measures and, in turn, modifies the sample size to maintain statistical power. Although the strategy is not novel, it is typically overlooked in psychopharmacology trials. The number of primary efficacy measures must be prespecified and carefully limited when a clinical trial protocol is prepared. If multiple tests are designated in the protocol, the alpha-level adjustment should be anticipated and incorporated in sample size calculations.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of changing from typical to atypical antipsychotic drugs on subjective sleep quality in patients with schizophrenia in a Japanese population.
To investigate the effects of the atypical antipsychotic drugs risperidone, olanzapine, quetiapine, and perospirone on the subjective quality of sleep in patients with schizophrenia. ⋯ These results demonstrated that atypical antipsychotic drugs improved subjective quality of sleep in patients with schizophrenia compared with conventional antipsychotic drugs, suggesting that the marked potency of serotonin-2 receptor blockade in atypical antipsychotic drugs may be involved in the mechanism of this improvement. These improvements were correlated with improvement of negative symptoms.