Question

• Consider the following scenario: Your patient has suffered from schizophrenia for two decades and has received classic dopaminergic treatments since the onset of illness. The latest research supporting use of the glutamatergic model has not been tried on your patient, and there is an opportunity for your patient to enter clinical trials utilizing glutamate-based treatments. Your patient suffers significant executive function impairment and memory impairment. Do you recommend participation in the clinical trial? Why or why not?

Answer 1

I recommend patient participation in the clinical trial as there is a growing awareness in the medical/nursing community about the scope of this glutamate based treatment..

There is clearly growing evidence for glutamate abnormalities in schizophrenia that supports the development of novel antipsychotic agents targeting this system. Early studies assessed the effectiveness of the glutamate based treatments on patients with schizophrenia have demonstrated significant effects, ESPECIALLY ON NEGATIVE SYMPTOMS, As we know the conventional dopaminergic antipsychotics is not very effective in the management of these negative symptoms of Schizophrenia. Drugs targeting the glutamate system also have a completely different side-effect profile to dopamine D2 antagonists, with no propensity to extrapyramidal side effects, prolactinoma or weight gain. It has been hypothesized that glutamatergic drugs may be of benefit to the 20–30% of individuals with schizophrenia who fail to show any response to dopaminergic agents. A number of glutamatergic compounds have been already reported as having promising results in phase II drug trials.

It is also noteworthy that my patient has not shown any significant clinical improvements by taking conventional dopaminergic drugs. Furthermore, it is also not a wise decision to wait till these drugs reach the market as it FDA approval is a time consuming process.

Again, it goes without saying that approproate INFORMED CONSENT SHOULD BE TAKEN from the patient's authorised legal caretaker/guardian/attender/relative.