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Xiang Y.-T.,Capital Medical University | Xiang Y.-T.,Chinese University of Hong Kong | Wang C.-Y.,Capital Medical University | Wang C.-Y.,Laboratory of Clinical Psychopharmacology | And 6 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2011

Objective: Relapse prevention is the main goal of maintenance treatment in schizophrenia. This study aimed to determine the rate and the socio-demographic and clinical predictors of relapse in Chinese schizophrenia patients following treatment of the acute phase of the illness. Methods: In a multi-center, randomized, controlled, longitudinal study, 404 patients with schizophrenia who were clinically stabilized following an acute episode were randomly assigned to either the maintenance (i.e., initial optimal therapeutic doses continued throughout the study) or the dose-reduction group (i.e., initial optimal therapeutic doses continued for 4 or 26 weeks followed by a 50% dose reduction that was maintained until the end of the study). Participants were interviewed at entry using standardized assessment instruments, and followed up for 12-26 months. Results: In univariate analyses, relapse was significantly associated with the membership of the dose-reduction group, poor medication adherence, and having a diagnosis of the paranoid type of schizophrenia. In Cox proportional-hazards regression analysis the membership of the dose-reduction group, poorer medication adherence, more severe drug-induced side effects and prominent paranoid symptoms independently predicted a higher risk of relapse. Conclusion: The study confirmed the importance of maintenance medication in preventing relapse in Chinese schizophrenia patients underscoring the risk of relapse associated with lack of treatment adherence, severe side effects and the patients' paranoid attitude. Socio-demographic characteristics were not associated with relapse in Chinese schizophrenia patients. Potential residual confounding caused by unmeasured variables should be fully considered in future studies. © 2010 Springer-Verlag.


Xiang Y.-T.,Capital Medical University | Xiang Y.-T.,University of Maryland College Park | Xiang Y.-T.,Chinese University of Hong Kong | Wang C.-Y.,Capital Medical University | And 8 more authors.
Pharmacopsychiatry | Year: 2011

Objective: This study aimed to characterize weight changes in schizophrenia patients taking risperidone as part of a randomized, controlled, open-label clinical trial. Methods: A total of 374 patients with schizophrenia who had been clinically stabilized following an acute episode were randomly assigned to a no-dose-reduction group (initial optimal therapeutic doses continued throughout the study), a 4-week group (initial optimal therapeutic doses continued for 4 weeks followed by a half dose reduction that was maintained until the end of the study) or a 26-week group (initial optimal therapeutic doses continued for 26 weeks followed by a half dose reduction until the end of the study). Participants were assessed monthly using standardized assessment instruments during the first 6 months, and then every 2 months until the last recruited patient completed the 1-year follow-up. Weight gain was defined as gaining at least 7% of initial body weight, weight loss as losing at least 7% of initial body weight. A BMI <18.5kgm2 was defined as underweight, 18.524.9kgm2 as normal range, and 25kgm2 as overweight or obese. Results: At the end of follow-up, of the patients who started within the underweight range (n=22), 77.3% gained weight, whereas 4.5% lost weight. The corresponding figures were 39.6% and 4.8% in patients who started at normal weight (n=273), respectively, and 17.7% and 17.7% in patients who started at overweight (n=79), respectively. At the same time, 59.1% of the patients who started at underweight range went into the normal weight and 13.6% into the overweight/obese range, respectively, while 24.5% of those who started at normal weight went into the overweight/obese range, and 1.1% into underweight range, respectively; 20.3% of those who started at overweight range went into normal weight at the end of the follow-up. Multiple logistic regression analyses revealed that being underweight or normal weight at study entry predicted weight gain compared to being overweight, whereas being overweight at entry was associated with a higher likelihood of weight loss compared to being normal weight. No correlation was found between weight change and dose reduction. Conclusions: Weight change is a common, long-term, but heterogeneous side effect in risperidone maintenance treatment for stable schizophrenia patients. Special attention should be paid to fluctuations in weight that may occur throughout the course of treatment with risperidone. © Georg Thieme Verlag KG Stuttgart - New York.


Guo W.,Laboratory of Clinical Psychopharmacology | Guo G.-X.,Laboratory of Clinical Psychopharmacology | Sun C.,Laboratory of Clinical Psychopharmacology | Zhang J.,Laboratory of Clinical Psychopharmacology | And 8 more authors.
Therapeutic Drug Monitoring | Year: 2013

OBJECTIVE:: To understand the status of therapeutic drug monitoring (TDM) of psychotropic drugs in psychiatric facilities in mainland China and to lay the foundation for improvement of TDM in psychiatry. METHODS:: A cross-sectional survey was conducted with a locally developed questionnaire among psychiatric facilities in which TDM of psychotropic drugs was available. The questionnaire included laboratory situations, implementation of TDM, equipment and analytical methods, internal quality control (IQC), and external quality assessment (EQA). RESULTS:: Forty-seven of the 58 delivered questionnaires were collected from the psychiatric facilities involving 26 provinces in mainland China. The response rate was 81.0%. Among all facilities surveyed, lithium was the most common psychotropic drug (68.1% of the laboratories) monitored by TDM, followed by clozapine (44.7%), carbamazepine (25.5%), chlorpromazine (21.3%), norclozapine (19.1%), risperidone (19.1%), paliperidone (17.0%), valproic acid (14.9%), and quetiapine (10.6%). Only 10.2% of the laboratories had recommendations for dose adjustments based on their TDM reports. Others only provided drug concentration results with no clinical recommendations. The analytical methods used included high-performance liquid chromatography, liquid chromatography with tandem mass spectrometric detection, and immunoassay. For lithium, most hospitals used ion-selective electrode methods. IQC and EQA were still in their infancy. CONCLUSIONS:: This first nationwide survey showed that TDM has been available in a considerable number of psychiatric hospitals across China. Though current equipment and analytical methods meet the TDM need, much improvement is needed, particularly in new analytical method development, interpretation of results, consultation services, and quality control, including IQC and EQA. Guidance or consensus guideline for TDM of psychotropic drugs in the Chinese language is also urgently required. Copyright © 2013 by Lippincott Williams & Wilkins.

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