TY  - CHAP
M1  - Book, Section
TI  - Measuring Patients' Experience
A1  - Furukawa, Toshi A.
A1  - Scott, Ian A.
A1  - Guyatt, Gordon
A2  - Guyatt, Gordon
A2  - Rennie, Drummond
A2  - Meade, Maureen O.
A2  - Cook, Deborah J.
Y1  - 2015
N1  - 
T2  - Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
AB  - CLINICAL  SCENARIOYou  are  a  psychiatrist  following  a  49-year-old  man  who  has  had  schizophrenia  for  more  than  20  years.  He  had  an  acute  psychotic  episode  in  his  mid-20s  and  was  admitted  to  a  psychiatric  hospital  for  3  weeks.  He  made  good  recovery  and  has  managed  to  continue  work  in  a  small  factory.  He  has  been  taking  chlorpromazine,  200  mg/d,  for  many  years,  still  has  occasional  hallucinations,  and  has  no  close  friends  except  for  his  sister's  family,  who  live  a  block  away.  Half  a  year  ago,  work  stress  increased,  the  patient  began  to  take  medication  only  irregularly,  and  he  experienced  a  mild  exacerbation,  becoming  fearful,  developing  insomnia,  and  hearing  voices  more  frequently.  You  increased  his  chlorpromazine  dose  to  300  mg/d,  and  the  patient  became  less  agitated  but  is  still  moderately  symptomatic.  After  taking  the  increased  dose  of  chlorpromazine,  the  patient  has  reported  hand  tremors  that  trouble  him,  and  his  movements  are  stiff.  He  does  not  mind  the  stiffness,  but  his  family  worries  because  “he  looks  odd,  aloof,  and  ill.”  He  and  his  family  now  wonder  whether  he  should  try  a  new  antipsychotic  drug  that  had  been  publicized  at  schizophrenia  support  group  meetings  they  have  attended.You  are  impressed  with  the  recent  report  of  a  government-funded  large  trial  comparing  4  newer  antipsychotic  drugs  and  1  old-generation  drug  (chlorpromazine  belongs  to  this  latter  class)  among  1500  patients  with  chronic  schizophrenia.1  The  authors  concluded  that,  although  most  of  the  patients  in  each  group  discontinued  use  of  their  medication,  olanzapine  proved  the  most  effective  in  terms  of  the  rates  of  overall  discontinuation  and  symptom  reduction.  Patients  did  not,  however,  tolerate  olanzapine  as  well,  and  the  drug  can  produce  weight  gain  and  elevations  in  blood  glucose  and  lipid  levels.After  hearing  about  the  treatment  options,  the  patient  comments,  “Doctor,  tell  me  how  much  better  I  will  actually  feel  while  taking  these  medications  and  also  what  side  effects  I  might  get.  I  care  more  about  these  than  being  able  to  stay  on  one  medication  longer  than  the  others.”  Skimming  the  article  in  question,  you  feel  you  are  incompetent  to  answer  this  patient's  questions.  You  promise  him  and  his  family  that  you  will  get  back  with  more  information  in  understandable  terms  in  a  week  and  advise  him  to  continue  taking  chlorpromazine  until  then.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - jamaevidence.mhmedical.com/content.aspx?aid=1183876504
ER  -