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Achieving remission in Schizophrenia is now possible
RLAI reduce relapse and hospitalization leading
to improved outcome- Prof. Pierre Chue
Even stable patients show benefits in switch over long term studies
and progressive improvement is seen with greater duration of therapy

COVENTRY (UK): Prof. Pierre Chue from Canada was one of the invited guest speakers at the Midland Psychiatric Research Group annual meeting held from June 8-10^th 2006. He was the first speaker in the morning session on June 9^th which was chaired by Dr. Andrew Ashley Smith and Prof. Mohan George. Prof. Chue spoke on Schizophrenia: goals of pharmacotherapy, future developments, consequences or relapse, compliance and the importance of Continuation of Anti Psychotic Medications (CAPM). The goals of pharmacotherapy in schizophrenia,  Prof. Chue said are  early and rapid access,  engagement and minimization of stigma, achieving remission is important, improving quality of life and prevention of progression of the disease

He then gave details of some atypical antipsychotics in Phase-II studies and said that relapse fuels progression of illness. After each relapse, recovery is slower and less complete. Regaining of previous function level becomes harder while uninterrupted therapy ensures optimal outcome.

Talking about ratio between observed treatment behaviour and accepted treatment standards Prof. Chue said that partial compliance in schizophrenia begins early and increases overtime. During first episode of psychosis, relapse rates are very high.  The patients do not take medications regularly hence the relapse rate is almost 80%.  Speaking about RLAI vs conventional Depot as to which works better, he pointed out that Ethical Boards will not approve such studies and it is not a standard practice. After twelve months treatment with RLAI, 83% of the patients were discharged and only 17% were in hospital. On the other hand after twelve months treatment with conventional antipsychotics, 58% patients were discharged and 42% were still in hospital. However, combination of antipsychotics reduces the side effects. This study showed that with RLAI there was reduction in hospitalization and relapse. In another study in 91 patients under treatment for seven years, important episodes reduced by 38% hence this was the greatest reduction in important episodes. There was progressive reduction in hospitalization during twelve months treatment with RLAI. Various studies have also shown reduction in cost of treatment with RLAI. Canadian experience also shows economic benefits of RLAI as their use saves money.

Speaking about their tolerability, Prof. Chue said that these drugs have low incidence of adverse events. As regards efficacy, they provide symptoms relief, relapse rate is reduced but treatment of co-morbidity cost goes up. It offers ease of use and from functional point of view activities of daily living are not affected much and quality of life improves. Giving details about the CATIE study, Prof. Chue pointed out that 74% of patients stopped taking drug during the first year. More patients stayed with olanzapine in first year but in the second year the response was better than olanzapine. In long term 70% of patients stayed with RLAI. As regards remission, there are mild symptoms in six months duration while in syndromal remission there are no symptoms at all. He concluded his presentation by stating that RLAI reduce relapse and hospitalization leading to improved outcome. Even stable patients show benefits in switch over long term studies. Progressive improvement is seen with greater duration of therapy. It offers high retention, continuation rate and achieving remission is now possible, he remarked

Prof. R. N. Mohan from UK was the next speaker who talked about recent case law changes and their implications for clinical practice. He was of the view that suitable amendments in the Mental Health Act are needed by the Parliament.