6. Bipolar Disorder and Schizophrenia: A Historical Perspective http://www.mindful-things.com/history_of_psych_home.html#120_70BC 1409 - First asylum in Seville, Spain 1934 - Electroconvulsive therapy (ECT) introduced by von Meduna 1978 - Dopamine hypothesis put forward to explain schizophrenia 1985 - U.S. NIMH's Consensus Conference on ECT concluded risks virtually eliminated and best used for depression and some mania 1300 1400 1900 1990 2005 1330 - Casting out devils in common use 1911 - Bleuler introduced term "schizophrenia" 1932 - Sakel introduced insulin coma therapy for schizophrenia 1952 - French researchers discovered chlorpromazine, marking the beginning of psychopharmacology 1983 - Researchers discover many schizophrenics cannot track moving target visually—close relatives also share this deficiency, even if not schizophrenic
7. Bipolar Disorder and Schizophrenia: A Historical Perspective 1990 2005 1990 - First atypical antipsychotic introduced-clozapine 1992 - APA and CPA establish clearer guidelines and standards for using ECT 1993 - Neuroimaging studies showed frontal, temporolimbic and basal ganglia involved in schizophrenia — Same abnormalities observed with other conditions, though to a lesser degree 1994 - Saykin, et al discover temporolimbic deficits of unmedicated, first-episode schizophrenic patients 2000 - American Psychiatric Association published the DSM-IV-TR , Diagnostic and Statistical Manual of the Mental Disorders Fourth Edition, Text Revision http://www.mindful-things.com/history_of_psych_home.html#120_70BC 2005 - Genetic biomarkers identified as basis for future blood test to confirm diagnosis of schizophrenia or bipolar disease
8. Factors Influencing the Variability of Clinical Practice Clinical Decision Clinical data Beliefs Peers Experience and training Competence Habits Emotions Comfort level
15. Observed Barriers and Expert Approaches to Achieving Optimal Performance with Atypicals Assure continuity and coordination of care, including offering intermediate care Break in continuity of care following discharge Rational approach to medication selection based on patient profile Ad hoc medication selection Rapid dose initiation to gain early control over acute symptoms Slow initial dose titration to avoid side effects Heightened vigilance for early psychosis symptoms Delaying the initial diagnosis Stay alert for first sign(s) of relapse Lack of vigilance around relapse Commit to a treatment and stick with it Failure to give adequate therapeutic trial Think long term when selecting your acute medication Focus on acute management Build rapport beginning with first interaction Neglecting to establish a relationship with the patient Expert Approach (Pearls) Barrier (Perils)
16. Overview of the Optimal Care Process Goal: Achieve best functional outcomes by reducing frequency of relapse
17. Overview of the Optimal Care Process Goal: Achieve best functional outcomes by reducing frequency of relapse Objective: Consider acute symptom control with long-term goals Objective: Adjust treatment program to achieve stability Objective: Maintain care to minimize relapse Objective: Make proper diagnosis, communicate it to patient
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22. Overview of the Optimal Care Process Goal: Achieve best functional outcomes by reducing frequency of relapse Objective: Consider acute symptom control with long-term goals Objective: Adjust treatment program to achieve stability Objective: Maintain care to minimize relapse Objective: Make proper diagnosis, communicate it to patient
31. Overview of the Optimal Care Process Goal: Achieve best functional outcomes by reducing frequency of relapse Objective: Balance acute symptom control with long-term goals Objective: Adjust treatment program to achieve stability Objective: Maintain care to minimize relapse Objective: Make proper diagnosis, communicate it to patient
38. Overview of the Optimal Care Process Goal: Achieve best functional outcomes by reducing frequency of relapse Objective: Balance acute symptom control with long-term goals Objective: Adjust treatment program to achieve stability Objective: Maintain care to minimize relapse Objective: Make proper diagnosis, communicate it to patient
43. Putting It All Together: The Care Process Goal: Achieve best functional outcomes by reducing frequency of relapse Objective: Balance acute symptom control with long-term goals Objective: Adjust treatment program to achieve stability Objective: Maintain care to minimize relapse Objective: Make proper diagnosis, communicate it to patient
44. Putting It All Together: The CareMap ™ Pierre Chue, F Markus Leweke, Ana González-Pinto on behalf of the CareMap Research Team. Sharing best practice in the management of schizophrenia and bipolar disorder: development of an atypical antipsychotic CareMap. Int J Neuropsychopharmacol 2006; 9 (Suppl 1): S261. Abstract number P03.124
Slide Unlike presentations of clinical study data, this slide set presents: Insights gained by observing physicians in practice who have achieved a measure of success using atypical antipsychotics for treatment of bipolar disorder and schizophrenia. Barriers to successful use that could be addressed by modeling clinical best practices and then implementing these insights. Tools and approaches that can help support physicians in implementing these best practices.
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