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Sunday 02 July 2006

Shortening the Hospital Stays of Patients with Acute Psychosis


A new study published by physicians from the Mental Health Research Institute and Monash University of Victoria, Australia, showed that all atypical antipsychotics studied were equally efficacious when used at optimal doses as primary medication for inpatients with acute psychosis.(1)

They were associated with remarkably brief hospital stays. This hospital-based study adds to the clinical evidence regarding patient response patterns to the best treatment approaches of acute psychosis in real-life clinical practice.

The study published in the International Journal of Psychiatry in Clinical Practice also found that patients treated with the atypical antipsychotics quetiapine, risperidone or olanzapine as primary treatment, in addition to adjunctive medications, showed a similar time to efficacy (mean time to efficacy was 11.2, 10.2 and 11.2 days, respectively).(1) The mean doses of atypical antipsychotics used were 567 mg quetiapine, 4.1 mg risperidone or 22.5 mg olanzapine.

Overall, hospital stays for these patients were remarkably brief despite their initial severe psychopathological disturbances. Patients treated with quetiapine, risperidone and olanzapine were discharged from hospital in just over two weeks (means of 17.0, 16.7 and 15.8 days, respectively). All medication schedules were associated with good tolerability and no serious side effects were seen. Patients receiving quetiapine required significantly less benzodiazepines as co-medication compared to patients receiving risperidone or olanzapine.

Lead investigator Professor Nicholas Keks, Mental Health Hospital Research Institute of Victoria, Australia, commented: “Acute psychosis is a severe mental condition that greatly disturbs the life of affected individuals and their families. The most important aim of therapy is to alleviate symptoms rapidly and, using medication optimally, to facilitate return to community care. The atypical antipsychotics studied clearly help to achieve a return to normal life for these patients.”

This study also examined a more rapid titration schedule of the atypical antipsychotic quetiapine (n = 32) than the current approved prescribing information. Most patients responded well to the accelerated titration, which started at 150-400 mg of quetiapine on day one and increased to higher doses in the course of treatment.

Prof Keks added: “Clinical guidelines are very important. However, it is even more important to fine-tune the therapy approach to the individual to achieve the optimal treatment outcome, especially in acute psychosis. Some patients seem to respond well to higher doses of atypicals or faster titration of quetiapine although larger studies are necessary to support our findings.”

Acute mental illness causes a significant strain on the healthcare and societal resources. Acute psychosis can appear suddenly in untreated individuals with schizophrenia, or schizophrenia-spectrum disorders, but also people suffering from bipolar disorder or major depression. It is estimated that approximately one percent of the population are affected by schizophrenia,(2) four percent by schizophrenia-spectrum disorders,(3) three to four percent by bipolar disorder(4) and six percent by major depression(5).

The retrospective, naturalistic study conducted by Professor Nicholas Keks and colleagues over a period of 12 months at Box Hill Hospital acute psychiatric care unit during 2001 included 137 inpatients who were prescribed atypical antipsychotics as first-line treatment for their acute psychosis. In total, 37 patients received quetiapine, 38 risperidone and 56 olanzapine in addition to other medications. Treatment protocols were developed from published guidelines.

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