Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: A survey to assess the usage pattern of amisulpride in the management of schizophrenia in India

Schizophrenia is a complex, chronic mental health disorder characterized by an array of symptoms, including delusions, hallucinations, disorganized speech or behaviour, and impaired cognitive ability. The prevalence of schizophrenia is between 0.6% and 1.9% in the U.S. population. The prevalence of the disorder seems to be equal in males and females, although the onset of symptoms occurs at an earlier age in males than in females.ⁱ In India, the prevalence of schizophrenia is about 3/1000 individuals. It is more common in men, and in terms of age of onset, men tend to be younger by an average of about five years than women when they develop schizophreniaⁱⁱ

Schizophrenia is characterized by positive and negative symptoms that can influence a patient’s thoughts, perceptions, speech, affect, and behaviours. Positive symptoms include hallucinations, voices that converse with or about the patient, and delusions that are often paranoid. Negative symptoms include flattened affect, loss of a sense of pleasure, loss of will or drive, and social withdrawal.ⁱⁱⁱ

Antipsychotic medications are the cornerstone of treatment for schizophrenia alongside psychosocial interventions. Despite the proven efficacy of antipsychotic medications and additional advantages of the new generation antipsychotics, one-fifth to one-half of schizophrenia patients are classified as refractory to pharmacological treatment and this proportion remains consistent over time. The management of treatment refractory schizophrenia (TRS) is a persistent public health problem, because a substantial number of inpatient psychiatric beds and resources are devoted to these patients, and because they experience the worst outcomes, such as suicide and homelessness.^iv

Amisulpride binds selectively to dopamine D(2) and D(3) receptors in the limbic system. Low doses of amisulpride preferentially block presynaptic D(2)/D(3)-dopamine auto receptors, thereby enhancing dopaminergic transmission, whereas higher doses block postsynaptic receptors, thus inhibiting dopaminergic hyperactivity. Amisulpride is clinically effective on the negative symptoms of acute schizophrenia exacerbations at low dosages (50-300 mg/day), and also on the positive symptoms of the disease at high dosages (400-800 mg/day).^v

A 12-week, randomized, double-blind, placebo-controlled study investigating the efficacy and safety of amisulpride augmentation therapy in clozapine-resistant treatment-refractory schizophrenia (CTRS) patients showed as compared with the placebo group, amisulpride group had a lower PANSS total score, positive subscore, and general psychopathology subscore at week 6 and week 12 (P _Bonferroni <0.01). Furthermore, compared with the placebo group, the amisulpride group showed an higher treatment response rate (P=0.04), lower scores of CGI severity and CGI efficacy at week 6 and week 12 than placebo group (PBonferroni <0.05). This study demonstrated that amisulpride augmentation therapy can improve the psychiatric symptoms and cognitive performance of CTRS patients^vi

This survey has been undertaken to assess the usage pattern of amisulpride in the management of schizophrenia in India.

As you will be spending some extra time to give your feedback on the questionnaire based on your clinical experience, we offer to pay you by cheque a professional fee of Rs {{$contractAmount}}, on receiving the completed Survey Questionnaire Form from you.

We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.