> Can anyone tell me - can it really be that much better than say, Sulpiride
> which is a lot cheaper. Any psych. lurkers around? A quick look in MIMS says
> it causes less extrapyramidal probs. but do those experienced in its use
> agree?
Not a psych lurker but we have reviewed this whole area recently (a
report is available - e-mail me privately if you are interested or
Leeds HA has a copy). In a nutshell:
Conventional antipsychotics have some major problems including:
1. Some patients are resistant and don't respond (up to 35%)
2. Extrapramidal symptoms (EPS)
3. Not much effect on negative symptoms
Together, these make for pretty miserable quality of life and
high health and social service costs. Enter the 'atypical' drugs,
atypical only in the sense that they don't cause EPS. At present,
the evidence for olanzapine is that it, unquestionably, causes fewer
EPS but there's no evidence that it's better for resistant
patients and any additional effect on negative symptoms is small. The
only published UK-based evidence on cost-effectiveness of atypicals
is some small-scale work on clozapine in treatment-resistant
patients where its use was demonstrated to be cost-saving or neutral
compared with conventional drugs.
Interesting question about sulpiride- it does appear to have a lower
incidence of EPS and, in some areas, is used before atypicals in
patients with troublesome or severe EPS.
Finally, FYI, the rate of annual cost growth nationally for
antipsychotics (BNF 4.2) in 1997 was 38%, second only to
lipid-lowerers.
Mark Campbell
Newcastle upon Tyne
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