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neerajsareen

essay plan for this topic

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'The battle between typical and atypical neuroleptic medications is biased. Critically discuss this statement.'

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'The battle between typical and atypical neuroleptic medications is biased. Critically discuss this statement.'

some ideas

*define typicals and atypicals, giving brief info on mech of action/ receptors, brief hx of discovery/ development of neuroleptics

*what the bias is, i.e towards atypicals now e.g NICE Guidelines 2002 on tx of schiz

*advantages of atypicals: effective, better side effect profile (in terms of EPSE, TD, akathisia, acute dystonia), better px compliance, available in preps such as orodispersible,

also some available as IM and depot preps, some now licensed as mood stabilisers

* advantages of typicals: been in existence for longer, so there is more experience in using them, more data exist, more RCTs done on them, may be safer in preg for this reason, most available in depot prep form, more cost-effective

*impt issues in medication choice: px wishes, px profile e.g weight, neuroleptic naive pxs, previous experience of S/E, dosing regimen, compliance

*contemporary practice, medicolegal issues, cost issues, variation in practice btw western countries & developing countries, variation in pracitice btw older & younger psychiatrists, and btw psychiatrists & other medical practitioners, data on different px groups - children & adolescents, elderly, LD etc.

Justme

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it hink we can sqeeze in some bits about various pharmaceutical companies promoting their products by giving a lot less info than required. The trials done during licensing are really biased etc etc..

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Also check out Davis et al, Archive Gen Psych 2003 60 p.553

Basically a meta-analysis of atypicals

There's also that paper about how first generation antipsychotics are as efficacious as second generation - would be good to add some controversy to the essay!

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Have to mention the CATIE study... which found no difference between typical and atypicals...

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And our own UK based Cutlass 1 and Cutlass 2 - shame on you if you don't

- these showed typical MORE effective although no statistical significant difference.

Not drug sponsored - like CATIE

Prob a good thing - more drugs too choose from

Bad thing? Studies long enough ?? - what about higher incidence of TD in long term with typicals.

is this regression?

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also to mention the earlier meta analysis by John Geddes as well in which he defends the typical antipsychotics as well

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And our own UK based Cutlass 1 and Cutlass 2 - shame on you if you don't

- these showed typical MORE effective although no statistical significant difference.  

Not drug sponsored - like CATIE

Oooops...

I am afraid CATIE is not industry sponsored... Its NIMH sponsored

Yanks are not bad always...

Cost utility/effectiveness of 1st vs 2nd... again the CUtLASS study shows that first generation is more cost effective than 2nd generation...

In this case it is enough to show they are equally efficacious and do not differ in side effects burden... (An example of proving the null hypotheis - Streiner)

n Number of limitations of  the studies... including ecological validity of the studies... and the fact that most number of patients on FGAs were on Sulpiride... which is more of an SGA (atleast according to Stahl)

Other points for the essay

Differential action of drugs on symptom/side effect domains

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