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February 05, 2007
Tailored Treatment of Schizophrenia
Making a strong case for tailoring the treatment of schizophrenia to the individual, rather than according to restrictive, cost-cutting formularies or even in strict adherence to guidelines, a subsection of a Medscape Continuing Education article, "Schizophrenia: Tailored Treatment vs Guidelines and Formularies", brings up advances made in patient genetic polymorphisms in receptor and transporter genes and drug-phenotyping, patient history of medications tried and adverse effects, compliance, and other variables that should come into play in a physician's choice of medications for an individual patient.
"Personalized care in psychiatry recognizes that because of the complexity and variety of psychiatric conditions, the genetic diversity of populations, and the variability of individual patients, clinicians need freedom to use their professional judgment in addition to evidence-based guidelines in selecting a treatment option that will achieve the best outcome for each patient."Restricting access to which drugs are used has been cited as increasing overall medical costs by increasing doctor visits, hospitalizations, and number and cost of yearly prescriptions.
Evidence is cited from studies such as the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE, U.S. National Institute of Mental Health) and the Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS, U.K. National Health Service) that the atypical antipsychotics are not interchangeable in spite of what restrictive formularies would lead the public to believe.
In order to justify restrictive formularies, an assumption is made that all drugs in this "class" have equal efficacy, as well as equal safety and tolerability.
Dr. Lawrence Cohen, Professor of Pharmacotherapy, Washington State University, asserts that "evidence-based medicine", which encourages the integration of research into practice should be used to support clinical judgment but not to replace it, nor to justify cost-containment initiatives.
The article concludes that
"Despite attempts to pigeon-hole psychiatric diseases into restrictive categories and diagnoses, clinicians encounter patients with a broad spectrum of histories, comorbidities, and physiologic backgrounds such that no 2 cases are ever alike. Medications, such as the second-generation antipsychotics, may have a wide variety of affinities for the array of neurotransmitter receptors and transporters, and may produce an unpredictable variety of reactions in different patients. Thus, restricting access to different drugs may not provide quality care and may even lead to higher costs when all treatment modalities are considered."
Read the full Article: Tailoring Medication Guidelines to Fit Psychiatric Patients' Needs (Free registration required)
Posted by Jeanie Wolfson at February 5, 2007 09:55 AM
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