Robert McMahon | University of Maryland Baltimore (original) (raw)
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Papers by Robert McMahon
Schizophrenia Research, 2008
Selecting the appropriate dose of antipsychotic medication is essential for successful long-term ... more Selecting the appropriate dose of antipsychotic medication is essential for successful long-term treatment in people with schizophrenia. However, there is much debate in the literature about the correct dosing of antipsychotics. This is especially true for quetiapine, a second-generation antipsychotic which experts have advocated using doses above the maximum recommended by the FDA of 800 mg/day. In this letter we report on a 12-week open label trial of high dose quetiapine for subjects with documented treatment refractory schizophrenia. All subjects were titrated to the target dose of 1,200 ± 200 mg/day over a three-week period. Subjects were evaluated weekly with the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Scale (CGI). Response was defined as ≥ 20% decrease in total BPRS score from baseline. Other weekly measurements included vital signs, the Simpson Angus Scale (SAS), Barnes Akathisia Scale (BAS), and the Assessment of Involuntary Movements Scale (AIMS). Laboratory assessments and electrocardiogram monitoring were done at baseline and end of study. Statistical analysis was conducted using the Cochran-Mantel-Haenszel method for monotonic correlations between scores and time, using a summary χ 2 statistic for evidence of time by visit correlations, stratifying the analysis with subject. Within-subject Spearman correlation coefficients between symptom scores and time were calculated, and the mean of these correlations calculated. Dichotomous variables were evaluated with Fisher's exact test. All analysis was done using SAS® 9.1 (SAS Institute Inc., Cary, NC) using two-tailed tests at α = 0.05.
Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, howev... more Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, however it is currently underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began and integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. Methods: We ascertained barriers related to clozapine management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (N=860). In parallel we tested clozapine sensing using a prototype point-of-care monitoring device. Results: 255 responses were included in the survey results. The two barriers receiving mean scores with the highest agreement as being a significant barrier were patient nonadherence to blood work and blood work’s burden on the patient (out of 28). Among nine solutions, the ability to obtain lab results in the physician’s office or pharmacy was top-ranked (mean±sd Likert scale (4.0±1.0)). Physicians responded that a point-of-care device to measure blood levels and WBCs would improve care and increase clozapine use. Residents ranked point-of-care devices higher than older physicians (4.07±0.87 vs. 3.47±1.08, p<0.0001). Also, the prototype device was able to detect CLZ reliably in 1.6, 8.2, and 16.3g/mL buffered solutions. Discussion: Survey results demonstrate the physician’s desire for point-of-care monitoring technology, particularly among younger prescribers. Prototype sensor results identify that clozapine can be detected and integrated for future device development. Future development will also include integration of WBCs for a complete detection device.
Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, howev... more Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, however it is currently underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began and integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. Methods: We ascertained barriers related to clozapine management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (N=860). In parallel we tested clozapine sensing using a prototype point-of-care monitoring device.
Schizophrenia Research, 2008
Selecting the appropriate dose of antipsychotic medication is essential for successful long-term ... more Selecting the appropriate dose of antipsychotic medication is essential for successful long-term treatment in people with schizophrenia. However, there is much debate in the literature about the correct dosing of antipsychotics. This is especially true for quetiapine, a second-generation antipsychotic which experts have advocated using doses above the maximum recommended by the FDA of 800 mg/day. In this letter we report on a 12-week open label trial of high dose quetiapine for subjects with documented treatment refractory schizophrenia. All subjects were titrated to the target dose of 1,200 ± 200 mg/day over a three-week period. Subjects were evaluated weekly with the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression Scale (CGI). Response was defined as ≥ 20% decrease in total BPRS score from baseline. Other weekly measurements included vital signs, the Simpson Angus Scale (SAS), Barnes Akathisia Scale (BAS), and the Assessment of Involuntary Movements Scale (AIMS). Laboratory assessments and electrocardiogram monitoring were done at baseline and end of study. Statistical analysis was conducted using the Cochran-Mantel-Haenszel method for monotonic correlations between scores and time, using a summary χ 2 statistic for evidence of time by visit correlations, stratifying the analysis with subject. Within-subject Spearman correlation coefficients between symptom scores and time were calculated, and the mean of these correlations calculated. Dichotomous variables were evaluated with Fisher's exact test. All analysis was done using SAS® 9.1 (SAS Institute Inc., Cary, NC) using two-tailed tests at α = 0.05.
Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, howev... more Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, however it is currently underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began and integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. Methods: We ascertained barriers related to clozapine management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (N=860). In parallel we tested clozapine sensing using a prototype point-of-care monitoring device. Results: 255 responses were included in the survey results. The two barriers receiving mean scores with the highest agreement as being a significant barrier were patient nonadherence to blood work and blood work’s burden on the patient (out of 28). Among nine solutions, the ability to obtain lab results in the physician’s office or pharmacy was top-ranked (mean±sd Likert scale (4.0±1.0)). Physicians responded that a point-of-care device to measure blood levels and WBCs would improve care and increase clozapine use. Residents ranked point-of-care devices higher than older physicians (4.07±0.87 vs. 3.47±1.08, p<0.0001). Also, the prototype device was able to detect CLZ reliably in 1.6, 8.2, and 16.3g/mL buffered solutions. Discussion: Survey results demonstrate the physician’s desire for point-of-care monitoring technology, particularly among younger prescribers. Prototype sensor results identify that clozapine can be detected and integrated for future device development. Future development will also include integration of WBCs for a complete detection device.
Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, howev... more Background: Clozapine is the most effective antipsychotic drug for schizophrenia treatment, however it is currently underused. In order to understand the barriers of frequent blood draws for white blood cell counts (WBCs) and clozapine levels, we developed a psychiatrist survey and began and integrative approach of designing a point-of-care device that could eventually have real-time monitoring with immediate results. Methods: We ascertained barriers related to clozapine management and the acceptance of possible solutions by sending an anonymous survey to physicians in psychiatric practice (N=860). In parallel we tested clozapine sensing using a prototype point-of-care monitoring device.