Current Research on Medications used in the Treatment of Schizophrenia Essay Example

Current Research on Medications used in the Treatment of Schizophrenia Paper The introduction of drugs to the treatment of schizophrenia heralded the modern era of psychopharmacology. The French anesthesiologist Hans Labroit was the first to note the antipsychotic effects of chlorpromazine while utilizing the drug as a preanesthetic medication. Medications have long been the primary component of effective treatment for schizophrenia (Denckner, 2001). Conventional antipsychotics have been in use since the 1950s. However, these medications have a number of unpleasant side effects. The use of the new generation of schizophrenia medications, generally known as atypical or novel antipsychotics, has increased dramatically over the past decade. The first medication in this series was clozapine, which, because of the higher risk of agranulocytosis, found limited application in routine clinical practice. In 1989, the Food and Drug Administration (FDA) approved clozapine, the first of a new class of antipsychotic medications. Although clozapine can cause agranulocytosis, a potentially fatal blood disorder that is reversible if the medication is stopped, it has far fewer of the extrapyramidal side effects typically associated with conventional antipsychotics (hence the term atypical). Atypical agents introduced in more recent years, such as risperidone, olanzapine, and quetiapine, have not been associated with an increased risk of this side effect and were shown in clinical trials to be at least as efficacious as conventional antipsychotics for schizophrenia and other psychotic disorders (Remington and Chong 1999; Worrel et al. We will write a custom essay sample on Current Research on Medications used in the Treatment of Schizophrenia specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Current Research on Medications used in the Treatment of Schizophrenia specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Current Research on Medications used in the Treatment of Schizophrenia specifically for you FOR ONLY $16.38 $13.9/page Hire Writer 2000). Randomized clinical trials have also shown that patients treated with these medications have fewer extrapyramidal symptoms and, as a result, have better adherence, fewer gaps in treatment, and fewer rehospitalizations (Rosenheck et al. 2000). The use of these new medications increased quickly after their approval by the FDA. By 1999, 58. 8% of all patients with schizophrenia who received an antipsychotic in the Department of Veterans Affairs (VA) were prescribed an atypical medication (Seeman et al. , 1996), and the proportion had increased to 64. 4% by 2000 (Wong et al. , 2005). However, little is known about the process by which these medications are adopted, i. e. , whether there is a simple switch to a new medication or a more complex process of trial and error. Literature Review The history of antipsychotic drug development is closely linked to the dopamine (DA) hypothesis of schizophrenia. This hypothesis postulates that schizophrenia is associated with a disorder in DA neurotransmission based on several observations: 1. Dopamine agonists, such as d-amphetamine, bromocriptine, and l-DOPA can exacerbate symptoms in schizophrenic patients and can produce psychotic symptoms in non-schizophrenic persons. 2. All currently used antipsychotic drugs share the common property of D2 dopamine receptor blockade both in vivo and in vitro. 3. A correlation exists between D2 dopamine blocking potential and clinical antipsychotic efficacy (Creese et al. , 2006). An increase in D2 dopamine receptors in the drug-naive schizophrenic brain has been reported but this finding has not been replicated (Wong et al. , 2005). In contrast, it has been shown that the D2 dopamine receptor and its gene are reported to be normal in schizophrenia and the antipsychotic drugs can only control symptoms and cannot cure the disease. While this hypothesis provided a rationale for the development of new drugs, there are still many unresolved problems. Not all schizophrenic symptoms can be explained by excess of dopamine. The positive symptoms of schizophrenia are related to a hyperdopaminergic state in the mesolimbic and mesocortical areas (Crow, 2005), and the negative symptoms to a hypodopaminergic state in the medial prefrontal cortical area (Merriam et al. , 2000). Therefore, a dopamine blocking agent cannot logically be the most suitable drug to improve both the positive and negative dimensions of schizophrenia. Current Pharmacological Treatment of Schizophrenic Patients Clinical Goals of Treatment Antipsychotic therapy focuses on four primary symptom domains in schizophrenia – positive symptoms, negative symptoms, cognitive impairments, and disturbance of mood and affect (Tandon et al. , 2005). Positive symptoms are prominent during acute exacerbations of illness, and often precipitate hospital admission. Negative symptoms include both primary and secondary components, due to either the illness itself or due to other factors such as depression, environmental deprivation, or parkinsonian side effects of antipsychotic medications (Miller et al. , 2000). Although they rarely precipitate hospitalization, they frequently worsen during acute psychotic episodes, and typically do not fully resolve after the episode. Negative symptoms are moderately associated with functional impairments between acute episodes of illness. Cognitive symptoms include deficits in all four major areas of neuropsychological function – memory, attention, language, and executive function. Although cognitive functions often show significant premorbid impairment, there is evidence that they continue to decline after the onset of illness, especially during acute episodes of illness. These symptoms are largely due to the underlying pathology of schizophrenia, but are also worsened by secondary factors, such as depression or pharmacologic treatment. Cognitive symptoms are highly correlated with lifetime functional impairment in schizophrenic patients (Bilder, 2007). Mood and affective symptoms common in schizophrenia include depression, anxiety, agitation, and behavioral dyscontrol. These symptoms contribute to subjective distress, functional impairment, and hospitalization, and are appropriate targets for pharmacologic intervention. The remarkable heterogeneity of schizophrenia is attributable in part to the relative contributions of each of these domains of pathology to individual cases of the disorder. Furthermore, the quality and severity of each type of symptom varies over the course of illness in the individual patient, creating a unique mosaic of symptoms over time. Antipsychotic treatment has usually been focused on positive symptoms, which respond most dramatically to pharmacologic interventions. Modest symptom improvement in other domains typically follows reduction in psychosis. There are two major reasons to focus more intently on negative, cognitive, and mood symptoms. First, they are highly correlated with patients’ functional status and quality of life. Second, because they are difficult to treat once they occur, it is critical to avoid the progression of these symptoms, which is usually associated with acute episodes of illness. Thus, prevention of acute episodes benefits the patient not only by avoidance of hospital admission, but also by minimization of the functional deterioration associated with progression of negative and cognitive symptoms. General Principles Antipsychotic medications have been the mainstay of the pharmacologic treatment of schizophrenia. AAP drugs show levels of antipsychotic efficacy comparable with the conventional agents, but are somewhat more effective in the treatment of negative, cognitive, and mood symptoms, and they carry a greatly reduced risk of EPS and TD (Meltzer, 1993). Clozapine is unique in its antipsychotic efficacy, effective treating 30% to 50% of patients who do not respond to other medications (Kane et al. , 1998). Because of its associated risk for agranulocytosis, seizures, hypotension diabetes and weight gain, clozapine is not considered a first-line agent, and is reserved for treatment-refractory cases. In treating a schizophrenic patient, two factors – the temporal and dimensional – need to be considered. Temporal factors include emergency, acute, chronic and rehabilitation treatments and dimensional factors include the positive, negative, cognitive and mood target symptoms. Acute Treatment Acute patients generally enter treatment through the emergency room and, if needed, may get admitted into the psychiatric ward of a hospital. The removal of the patient from the stressful environment, if any, is itself positive. In an acute setting, antipsychotic monotherapy is the most useful line of treatment, and AAP drugs are preferred because of the lack of acute EPS. Antipsychotic drugs are used in therapeutic doses and in most instances, use of high doses is not needed. There is no evidence that schizophrenic patients respond to any one specific medication and the response depends on the individual. Intramuscular preparations are sometimes required to treat acute patients; both haloperidol and ziprasidone are available in intramuscular formulation. Occasionally, lorazepam intramuscularly either alone or with haloperidol is administered to decrease agitation (Salzman, 1988). The goal in acute treatment is to prevent harm to self or others by decreasing excitatory symptoms. When to Expect improvement Positive symptoms improve first. Of the positive symptoms, psychomotor excitement improves in a day or two and sometimes in a few hours. Akathisia and dystonia also occurs most often with in the first 48 hours to a week, and patients need to watched carefully during this period. Hallucinations and delusions take about 3 months to improve and, in some instances, may continue unabated. Thought disorders improve gradually. There is variability in how an individual patient responds. Adjunct medications, increase in antipsychotic medication dose, addition of another antipsychotic drug, or changing the antipsychotic agent within a month is unwise. Maintenance Treatment Continuing antipsychotic medication treatment after acute symptoms are controlled reduces the likelihood of a relapse (Davis, 1995). The antipsychotic medication should be continued indefinitely. Depot injections decrease relapse rates better than oral medications and are indicated in certain circumstances. Tardive dyskinesia is a major risk with CAP drugs, occurring in about 5% of the haloperidol treated patients per year. In older patients, in one year 27 % of patients develop tardive dyskinesia (Jeste Caligiuri, 1993). It is the risk of tardive dyskinesia which is partly responsible for the popularity of AAP drugs as the first choice for treatment. Dose of the medication is an unsettled issue. With regard to antidepressant therapy, the dose that helped a person to improve is the same dose used as maintenance dose. With antipsychotic drugs, there is a need to use the minimum amount necessary to prevent relapses. What the minimum dose is, is a clinical decision. The maintenance antipsychotic treatment has to be flexible to suit the individual needs with a positive risk-benefit ratio. Discussion The introduction of chlorpromazine a half century ago clearly revolutionized the treatment of schizophrenia and other psychotic disorders. Unfortunately, neither this drug nor other typical antipsychotic medications are uniformly or optimally effective in the treatment of individuals with schizophrenia. These agents do not reduce psychotic symptoms in all patients and have limited efficacy against other clinical features of the illness (e. g. , negative symptoms and cognitive deficits). In addition, the different side effects associated with these medications have both contributed to problems with compliance and introduced additional sources of morbidity. The availability of atypical agents, such as clozapine, olanzapine, and risperidone, promised advantages in both efficacy and tolerance but raised very important questions, such as, 1) Which antipsychotic medication used is best for a given profile of symptoms of schizophrenia? and 2) just how much advantage in treatment efficacy, especially for negative symptoms, do the current atypical medications actually provide? Clear answers to these questions have been difficult to obtain from the existing literature because the available studies evaluated only a subset of the medications of interest, used different experimental designs and outcome measures that hinder comparisons across studies, and examined primarily acutely ill subjects, making it difficult to determine whether clinical improvement reflected reductions in not only secondary but also primary negative symptoms. In addition, a number of the comparative studies that have been published were developed and sponsored by the pharmaceutical companies whose medications were being evaluated, raising concerns about potential sources of bias in experimental design or interpretation of outcomes. The study by Papanikolaou and colleagues provides compelling new data that address these important issues. These investigators recruited 157 inpatients who had a diagnosis of chronic schizophrenia or schizoaffective disorder and a history of suboptimal treatment response to adequate duration and doses of one or more typical antipsychotics. The patients were randomly assigned to receive clozapine, olanzapine, risperidone, or haloperidol in a 14-week, double blind trial. Total Positive and Negative Syndrome Scale scores were significantly improved for all three patient groups treated with atypical agents but were unchanged for the haloperidol treated group. This finding would be expected for individuals who were selected for study because 1) they had not responded adequately to previous treatment with typical antipsychotics and 2) they had not failed previously to respond to treatment with atypical agents. When compared with haloperidol treatment (with conservative corrections for the performance of multiple statistical tests), only clozapine and olanzapine demonstrated statistically significant improvement in negative symptoms. In addition, none of the three atypical antipsychotics produced a statistically significant improvement in positive symptoms or general psychopathology compared with haloperidol. In considering the significance of these findings, several aspects of this study are worthy of note. First, the importance of such double-blind direct comparisons of therapeutic agents is rivaled by the difficulties involved in conducting such studies. For example, achieving the optimal dose for each agent can be a major challenge; as noted by the authors, the dose of risperidone was probably too high, presenting one limitation to the study. In addition to the complexity involved and time required to conduct these types of studies, the staged introduction of new medications produces problems in making direct comparisons across medications. In the study by Papanikolaou et al. , the comparison of haloperidol, clozapine, and risperidone was designed and implemented when olanzapine became available commercially. To enhance the relevance of their study to clinical practice, the investigators subsequently added an olanzapine treatment arm. However, the later addition of olanzapine-treated subjects meant that assignment to treatment with olanzapine was not completely random with the other three medications, creating the possibility of a cohort effect. This raises the question of whether subjects who entered the study later, and received olanzapine, were somehow different from the subjects who entered the study earlier, and received the other drugs, in a way that would account for any differential response (or lack thereof) to a given treatment. The authors have thoughtfully addressed this question and provide reasonable arguments for the absence of such a cohort effect, but they acknowledge that the possibility cannot be completely excluded. Second, the study was supported by a grant from the National Institute of Mental Health (NIMH), contributions of medications from four pharmaceutical corporations, and supplemental funding for the olanzapine arm (equal to about 18% of the total cost of the project) from Eli Lilly and Company, the manufacturer of olanzapine. This arrangement, a realistic compromise that made possible the direct comparison of four drugs, nonetheless raises concerns about potential bias, given that olanzapine proved to be more effective than other drugs on some measures. However, in contrast to investigations that are initiated and controlled by industry, the authors had complete independence in the design, conduct, analysis, and interpretation of the study. In some ways, this study may represent a model approach for the support of clinical trials; that is, the study was designed and conducted by independent investigators, principally funded by the federal government, and supplemented by contributions from, but without undue influence by, the pharmaceutical industry. Indeed, such government/private collaborations for investigator-initiated research have been encouraged by NIMH. Third, despite achieving statistical significance, the differences in efficacy across the medications examined in this study were, as noted by the authors, modest and their clinical significance limited. Thus, the disappointingly small added value of atypical antipsychotics in this patient population clearly underscores the need for the identification of more effective treatments. In this regard, the study by Leucht et al. (1999) in this months Journal provides an informative lesson. These authors conducted a meta-analysis of amisulpride, an atypical atypical antipsychotic that has been used clinically in France for the past decade. Leucht et al. found that amisulpride was superior to typical antipsychotics in improving global symptoms and negative symptoms in acutely ill patients with schizophrenia and more effective than placebo (but not than typical antipsychotics) in patients with predominantly negative symptoms. However, as in the study by Papanikolaou et al. , the additional improvement provided by amisulpride was relatively small. For example, the mean effect size was 0. 11 in acutely ill patients, indicating 11 percentage points more improvement in Brief Psychiatric Rating Scale total score with amisulpride than with typical antipsychotic medications. In addition to clarifying the clinical efficacy of amisulpride, the findings of Leucht and colleagues are informative regarding the pharmacological basis for the atypicality of antipsychotic medications. Although it shares the clinical properties (e. g. , reduced extrapyramidal symptoms at therapeutic doses) that characterize other atypical agents, amisulpride is unusual in that it lacks the combination of activity at dopamine D2 and serotonin 5-HT2 receptors that has been proposed to account for the efficacy and side effect profile of atypical antipsychotics (1). In contrast, amisulpride is a highly selective antagonist of dopamine D2/D3 receptors. Thus, the superiority of amisulpride in terms of clinical response and reduced extrapyramidal symptoms suggests that activity at the serotonin 5-HT2 receptor is not required for atypicality. As a consequence, these findings may indirectly support the hypothesis of Seeman and Kapur (1996) that fast dissociation from the dopamine D2 receptor accounts for the distinctive features of atypical antipsychotic medications. Conclusion The findings of both studies may further enhance the ability of clinicians to make informed, evidence-based decisions regarding the antipsychotic medication that is most likely to be effective in individual patients. However, the modest differences in clinical efficacy of a given atypical medication relative to typical antipsychotics, and especially in comparison with other atypical antipsychotics, both warrant caution in the face of marketing claims of superiority for a given drug and underscore the continued need for the types of basic research that can contribute to the development of novel and more effective medications for the treatment of schizophrenia. REFERENCES Bilder RM. (2007). Neurocognitive impairment in schizophrenia and how it affects treatment options. Can J Psychiatry; 42: 255-264. Creese I, Burt DR, Snyder SH. (2006). Dopamine receptor binding predicts clinical and pharmacological potencies of antischizophrenic drugs. Science; 192: 481- 83. Crow T. (2005). The two syndrome concept: Origins and current status. Schizophrenia Bull; 11: 471-86. Davis JM (1995). Overview: maintenance therapy in psychiatry: I. Schizophrenia. Am J Psychiatry; 132(12): 1237-45. Denckner S (2001). The need for long-term neuroleptic treatment in schizophrenia. Acta Psychiatric Scand Suppl; 291:29-43 Jeste DV, Caligiuri MP (1993). Tardive dyskinesia. Schizophrenia Bull 1993; 19(2): 303- 315. Kane J, Honigfeld G, Singer J, Meltzer H. (1988). Clozapine for the treatment-resistant Schizophrenic: a double blind comparison with chlorpromazine. Arch Gen Psychiatry; 45: 789-796. Leucht S, Pitschel-Walz G, Abraham D, Kissling W. (1999). Efficacy and extrapyramidal side effects of the new anti psychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional anti psychotics and placebo: a meta-analysis of randomized controlled trials. Schizophrenia Res; 35:51- 68. Meltzer HY (1993). New drugs for the treatment of schizophrenia. Psychiatry Clinical North Am; 16: 365-385. Merriam AE, Kay SR, Opler LA, Kushner SF, van Praag HM (2000). Neurological signs and the positive-negative dimension in schizophrenia. American Journal of Psychiatry 28: 181-92. Miller DD, Tandon R. (2000). The Biology and Pathophysiology of Negative Symptoms. In: Keefe R, McEvoy J. Eds, Negative Symptom of Schizophrenia. Washington, DC, American Psychiatric Press; 163-186. Nasrallah HA Eds. (2005). Contemporary Issues in the Treatment of Schizophrenia. Washington, DC, American Psychiatric Press; 109-124. Papanikolaou, Wiesel FA, Stone-Elander S, Halldin C, Nordstrom AL, Hall H, et al. (1990). D2 dopamine receptor in neuroleptic naive schizophrenic patients. Arch Gen Psychiatry; 47: 213-19. Remington, G. , and Chong, S. A. (1999). Conventional versus novel antipsychotics: Changing concepts and clinical implications. Journal of Psychiatry and Neuroscience, 24:431-441. Rosenheck R, Cramer J, Xu W, Thomas J, Henderson W, Frisman L, Fye C, Charney D. (1997). (Department of Veterans Affairs Cooperative Study Group on Clozapine in Refractory Schizophrenia): A comparison of clozapine and haloperidol in hospitalized patients with refractory schizophrenia. N Engl J Med ; 337:809-815 Salzman C. (1988). Use of benzodiazepines to control disruptive behavior in inpatients. J Clinical Psychiatry; 49(suppl): 13-15. Seeman P, Lee T, Chau-Wong M, Wong K. (1996). Antipsychotic drug doses and neuroleptic/dopamine receptors. Nature; 262: 717- 19. Tandon R, Jibson M, Taylor SF, DeQuardo JR. (2005). Conceptual models of the relationship between positive and negative symptoms: Implications for pathophysiology and treatment. Wong DF, Wagner HN Jr, Tune LE, Dannals RF, Pearlson GD, Links JM, et al. (2005). Positron emission tomography reveals elevated D2 dopamine receptors in drug naive schizophrenics. Science; 244: 1558-63 Worrel, J. A. ; Marken, P. A. ; Beckman, S. E. ; and Ruehter, V. L. (2000). Atypical antipsychotic agents: A critical review. American Journal of Health-System Pharmacy, 57:238-255.

Lithuania Eu Cultural Policy Area Essays

Lithuania Eu Cultural Policy Area Essays Lithuania Eu Cultural Policy Area Essay Lithuania Eu Cultural Policy Area Essay Lithuanian Cultural Policy and the European Union The cultural policy has been adopted by the European Union during the 1990s with the aim of creating a European identity which would bring the people of Europe closer and which would lead them to identify themselves as â€Å"Europeans†. On the other hand, the cultural policy adopted by the Union remained supplementary in its character as the member states did not want to lose their sovereignties, especially on such an issue that underlines the national identities, (Sassatelli, 436) As a result, the European cultural policy became one that respects and tries to protect the national cultures of the member states on the one hand, while it tries to create a European culture and identity on the other. In other words, the main aim of the European cultural policy is to create unity in diversity. Sassatelli, 30) Although it is supplementary in character and although the Union is not the decision maker in the cultural matters, the member states are expected to follow the cultural policy of the Union which suggests them to protect their national heritage, cooperate with other member states in cultural matters, to promote an inclusive national culture, to adopt a democratic, open and competitive national cultural policy. Lithu ania, which became a member of the European Union in 2004, had a different cultural policy understanding than the Union and its member states as it was a Communist country. With the end of Communism and with the aim of becoming a member of the European Union, Lithuania has changed its cultural policy and shaped the new policy according to the idea of cultural policy adopted by the Union; a competitive, inclusionary, and based on cooperation. European Union Cultural Policy The first steps towards the establishment of a cultural policy in the European Union were taken during the late 1970s, when the European Union was European Community. In the 1973 with the wave of enlargement and with the economic crisis the Community faced, the member states signed a Declaration of the European Identity. With the Declaration they stated that the member states of the Community share common attitudes and their aim is to build a society which gives priority to the individuals. (Bozoki, 2) The low turn out in the first direct elections for the European parliament made the Community to realize that there was a need to take measures for unification of peoples of Europe as it became obvious that economic integration alone would not lead to such thing. In 1984, the European Council set up a Committee for a People’s Europe. The main aim of the Committee was to take necessary measures to strengthen the European identity. The Committee produced two reports in both of which it was suggested to increase cooperation between the member states in the area of culture, information, and communication. The reports also argued for the development of cultural projects in the form of cultural exchanges, town twining schemes, and youth programs (Bozoki 3). However, the reports were away from proposing a common cultural policy. Another attempt to create a European cultural policy came in the mid 1980s when the Community was preparing itself to the Single European Act, which created the internal market. In 1985, the Delors Commission started to implement the proposals of the Committee for a People’s Europe. During the time the blue flag with twelve stars were adopted as the official flag of the Community. European passports, driving licenses were introduced together with the European postage stamps. (Bozoki, 3) The European Cultural Area was created with the aim of promoting educational exchanges, translation of literary works, and town twining schemes. Another program that was adopted during the time was the Cultural Capitals of Europe. The European Union has legalized its cultural policy with the Treaty of Maastricht, the treaty establishing the European Union, for the first time in 1991. The 151. Article of the treaty states â€Å"The Community shall contribute to the flowering of the cultures of the Member States, while respecting their national and regional diversity and at the same time bringing the common cultural heritage to the fore†. Bozoki, 4) The article on the Cultural Policy further suggests that â€Å"Cultural policy is governed by the principle of subsidiarity, with Community action is to be taken only if the objective cannot be achieved sufficiently by member states alone. Thus EU-level cultural policy is limited to encouraging cooperation between member states, and, if necessary supporting and supplementing their action†. (Bozoki, 4) According to the article the Union should take into consideration cu ltural compatibility when it implements cultural policies. The European Cultural Policy had three aims. The first one of these was to improve the knowledge of the culture and history of the Europe and its people. The second aim was to conserve the European cultural heritage and the last aim was to support the cultural exchange and artistic creation. In order to achieve these aims three cultural programs have been implemented by the Union between 1996 and 1999. The first one of these programs was â€Å"Kaleidoscope†. The aim of the program was to encourage artistic creation and promote cultural awareness among the peoples of Europe in the areas of creative arts, performing arts, and applied arts by means of exchange and cultural cooperation. Kouveliotis, 5) The second program was â€Å"Ariane†. It aimed to promote knowledge of European literary works through the means of translation. The objective of the program was to create awareness in the member states regarding the current literary art together with the current drama. (Kouveliotis, 6) The third program that implemente d in the 1997- 2000 period was â€Å"Raphael†. The aim of the program was to encourage cooperation among the member countries of the Union in the area of cultural heritage. Kouveliotis, 8) The program aimed to bring the common cultural to the fore while respecting the national diversities. The European Capital of Culture was another program that adopted by the European Union. The main objective of the program was to highlight the diversity and richness of European cultures and to promote greater mutual acquaintance between European citizens. (Kouveliotis, 10) Under the program starting from 2005, each year a city would be chosen as the European capital of culture. The objectives of the program were to highlight the artistic movements and styles shared by Europeans, to promote events involving people active in culture from other cities in the member states of the Union, to ensure mobilization and participation of large sections of population, to encourage reception of citizens of the European Union and to reach as wide an audience as possible by employing multimedia and multilingual approach, to promote dialogue between European cultures and other cultures in the world, to exploit the historic heritage, urban architecture, and quality of the city. Kouveliotis, 10) In the year 2000, the Union adopted Culture 2000 program under which all the three programs were merged. The Culture 2000 program aims to promote creativity and disseminate culture through support Europe wide cooperation between cultural organizations, institutions within and outside of the Union (Kouveliotis, 12). Under the program three types of activities were defined to be support ed. These are innovative activities, experimental actions of multiannual cultural cooperation, and cultural events with European dimension. Kouveliotis, 12) In 2007, Culture 2007 program was implemented by the Union for the period of 2007- 2013. (Dewey, 99) The main aim of the program is to focus on the mobility of artists and art works in order to enhance cultural cooperation in the Union. Lithuanian Cultural Policy Lithuania is one of the countries that faced transition from Communism to liberal democracy. Like all other policies the cultural policy of the country was also affected by that change in the regime. During the Soviet period the cultural policy of the country were under the control of the Communist Party (Council of Europel/ERICarts 2). In other words, the cultural policy of the country was under an ideological influence and control. The Soviet cultural policy and its administration were under the lines of strict command of the party. The cultural events and institutions were used by the party to legitimize Communism. The privileges were offered to the artists. In this way the artists were attracted to the ruling circles and they were prevented to produce artifacts criticizing the regime (Council of Europel/ERICarts 2). As a result of such policy implementation, democratic forms of cultural self government cannot be established in Lithuania. Lithuania was one of the post-Soviet era East European countries that applied European Union for full membership. Like all other candidate countries, Lithuania had to take the necessary steps in order to fulfill the criteria defined by the Union in order to become a member of the Union. The Maastrich criteria, which Lithuania was expected to fulfill, consist of three criterions. The first one of these is the political according to which every candidate country should adopt rule of law, respect minority rights, and stable democratic institutions. Varbanova, 54) The second criterion is the economic one. Under this criterion a candidate country should adopt a well functioning market economy and should be able to compete in the European market. (Varbanova, 54) The third criterion is the adoption of â€Å"acquis communautaire† and the last criterion is to have the capacity to fulfill the membership obligations. As far as the cultural policy during the accession process is concerned , the candidate countries are required to complete a questionnaire on the economic and public sectors which includes ulture and audio visual policy. (Varbanova, 54) The questionnaire includes legislation for protecting cultural heritage, legislation in the field of broadcasting, the national system for the support of artistic activities, professional training, and arts education. (Varbanova, 54) In this respect, Lithuania benefited from the European financial support schemes provided to candidate countries under the Culture Program, Structural Funds, and European initiatives to advance cultural cooperation. With the end of the Communist regime in 1989, a new era in the Lithuanian politics has started. The country turned its face to Europe and started to implement the necessary measures to be a liberal democracy. This process also affected the Lithuanian cultural policy. In the year of 1991, the Lithuanian government has adopted a new program called â€Å"Market†, Democracy Freedom which set a new direction of the Lithuanian cultural policy as the program included a specific objective which was the development of a â€Å"Lithuanian Cultural Model†. Dufton, 15) This new cultural model aimed to bring freedom of expression, democratic process and an arms length approach, according to which the policy making and policy implementation in the area of culture would be separated from each other. In other words, the new program brought decentralization to the Lithuanian cultural policy. On the other hand, throughout the 1990s the decisions taken regarding the cultural policy in Lith uania cannot be taken appropriately due to the some problems faced by the country. The first problem the country faced regarding the cultural policy was the lack of money as a result of which the projects could not be implemented. The second problem was the lack of local government tradition. The third problem was the exclusion of some sectors of the population from cultural activities and the fourth problem was the contradictions in the legislation. (Dufton, 18) The cultural activities which were financed by the central and local government generally were spent on the existing cultural institutions such as theaters, cinemas, libraries etc. As the number of the audiences and the performances decreased the burden of financing the cultural activities started to rest with the government. (Dufton, 19) The decision making process regarding the cultural policy was at the hands of the high executives. As a result, most of the important channels were cut off from the process, leading to disintegration in cultural services. (Dufton, 19) As the problems in the above mentioned areas continued to exist, Lithuania passed a law, Law on the Amendment of the Law on Local Self-Government, for the decentralization of the cultural policy making and implementation. The law provided the local governments the legal and administrative capacities to implement cultural policy according to the needs of their communities. Another development in the decentralization of cultural policy came in 2002, when the Lithuanian government adopted the Cultural Development Program of the Regions, with the aim to form the administrative, financial, legal and information basis for the development of regional culture (Council of Europel/ERICarts 10). In 2002, Lithuania adopted a document called â€Å"State’s Long Term Development Strategy† defining the aims of the Lithuanian cultural policy as â€Å"to preserve and promote common European cultural values and national identity, to warrant its prolongation, openness and competitiveness in contemporary Lithuanian, European and the World cultural context†. (Council of Europel/ERICarts, 11) Furthermore, the new cultural policy aimed to guarantee participation in culture life of the Lithuanian society and consumption of culture. The cultural identity of the Lithuanian culture was defined as the use of national language, state protection of the ethnic culture, national heritage, and support national minorities living in Lithuania. (Council of Europel/ERICarts, 12) Moreover, the cultural policy aimed to improve the administrative system on national heritage protection, expand the democracy in cultural life, to set the basic principles for state’s support to art and artists, to stimulate regional cultural development and cooperation of tourism and cultural institutions, and to develop the information society and access to culture. Council of Europel/ERICarts, 12) In this respect it can rightly be argued that the cultural policy adopted by Lithuania was in line with the cultural policy objectives of the Union. It aimed to promote European values as a part of the Lithuanian culture, to promote cooperation with other states regarding the cultural programs, to increase the participation of the Lithuanian soc iety in cultural programs and to promote the Lithuanian culture in such a way that all the different elements of the Lithuanian society would be reflected. Current Issues in Lithuanian Cultural Policy National minorities and their place in the Lithuanian cultural policy are some of the current issues in the Lithuanian cultural policy. Lithuania has been one of the first Central and Eastern European counties which passed the Law on National Minorities. (Council of Europel/ERICarts, 13) Under this law the national minorities have the right to receive state support for fostering of their national culture. They have access to information and press in their native language and to establish cultural and educational organizations. Furthermore, the national minorities are given the right to organize cultural events in their native languages. Moreover, the minorities have the right to publish books and newspapers in their own languages. In addition to this, according of the Law of Education the educational institution should provide information on ethnic cultures into their curricula. (Council of Europel/ERICarts, 13) In 2004 the Lithuanian government passed the Program of Integration of National Minorities into Society for the years 2005-2010 with the objectives of integrating national minorities into Lithuanian cultural life, preservation of ethnic identities of minorities, and development of coherent relationships with the minorities. Council of Europel/ERICarts, 14). The state and the municipalities provide financial support for the cultural organizations and events of the national minorities. As it is mentioned above another main objective of the Lithuanian Cultural Policy is to promote openness of the Lithuanian national culture through promoting Lithuanian culture abroad and to familiarize the local population with the culture of other nations. The regions where the national minorities lived as majorities have adopted special cultural programs and education programs. Council of Europel/ERICarts, 14) In addition to integrate the national minorities into the culture of Lithuania, these programs also aim to bring regional economic development to these areas. As it is mentioned above, one of the aims of the Lithuanian cultural policy is to bring equal access to the culture to everyone in the culture life of the country. The programs adopted by the government such as The Regional Culture Development Program and the Support to Young Artists Program brought measures to increase the participation to regional cultural events and to integrate the young artists into the cultural market. Council of Europel/ERICarts, 14) Although the state remained as the main supported of the above mentioned cultural programs, the private sector started to emerge as an important supporter and initiator of cultural events in Lithuania. Private sector in cooperation with NGOs implemented many social cohesion acts such as the Open Air Museum of the Centre of Europe, which also was included into the Culture 2000 Project of the Union. (Council of Europel/ERICarts, 14) Artistic Parks in Nature: the Bridge for Teaching Contemporary Art in Schools was a project developed by the private sector and NGOs. It involved young people and professional artists from different countries. The project, Uzupio Respublika has been one of the important projects developed under the Lithuanian cultural policy. (Council of Europel/ERICarts, 14). It was started by a group of young artists in 1990s. It became an important place for the cultural organizations such as festivals. Publications of books and film productions also have taken their places in the Lithuanian Cultural Policy. Translation of foreign books into Lithuanian language has become one of the priorities according to the cultural policy of the country. As far as the film production is concerned, the state plays an important role in the financial support. After the accession to the European Union the film producers started to cooperate with companies from other countries. The cultural heritage and its protection is one of the important areas under the Lithuanian cultural policy. In 1994 with a law passed by the government, the Law on the Basic National Security of Lithuania, cultural heritage became a national security object. (Council of Europel/ERICarts, 17- 18) During the last years the government has taken several steps in the area. Training programs for the protection of national heritage were implemented with the fund provided by World Heritage Fund. The protection of the heritage was also decentralized as the local authorities were given more funds for the protection of heritage. However, the insufficient funding remains as an important problem in the protection of heritage. Conclusion Lithuania has adapted its cultural policy according to the cultural policy aims of the European Union. The country has taken the necessary measures to protect its national culture, including the culture of the national minorities. It has developed and implemented programs in order to familiarize its society with the different cultural elements that existed within Lithuania. The country also developed cultural programs to promote the Lithuanian culture abroad and cooperated with other countries in this regard. Moreover, the country has also promoted the idea of protection of national heritage and has taken the necessary steps, despite some financial problems the policy regarding heritage works well. In 2009 Lithuania involved in the European Capital of Culture Project with Vilnius. In this regard, it can rightly be stated that the Lithuanian cultural policy has affected by the ideas promoted by the European cultural policy in the sense that Lithuania promoted a democratic national cultural policy, embracing the European identity and promoting the Lithuanian one. As far as the other side of the coin, the European cultural policy is concerned, it can be suggested that the Union’s cultural policy is not affected by the Lithuanian cultural policy. But as it is the case with other member states, Lithuanian cultural policy contributes to the development of the European culture and identity. With the adopted projects Lithuanian culture is known in other member states of the European Union and the European identity gains another component; Lithuanian. In other words, the programs promoted by the Union which are adopted and implemented by Lithuania enrich the European culture and identity. Bibliography Bozoki, Andras. Cultural Policy and Politics at European Union. Retrieved 01. 05. 2009, from â€Å"137. 204. 115. 130/activities/download/Bozoki/Cultural%20Policy%20and%20Politics%20in%20the%20Eu † Council of Europe/ERICarts: Compendium of Cultural Policies and Trends in Europe. 10th edition 2008. ttp://www. culturalpolicies. net/web/index. php Dewey, Patricia (Summer 2008) â€Å"Transnational Cultural Policymaking in the European Union. † The Journal of Arts Management, Law, and Society. vol 38. 2 (Summer 2008): 99- 118. EBSCO. Suna Kirac Lib. Koc U. http://0web. ebscohost. com. libunix. ku. edu. tr. Dufton, Bill. (1998) â€Å"Cultural Policy in Lithuanina. † Council of Europe. Cultural Development Policies in Member States. Retrieved 02. 05. 2009, coe. int/t/dg4/cultureheritage/Source/Policies/Reviews/CC-CULT(97)24B_EN. pdf Kouveliotis, Kyriakos. â€Å"The Impact of EU’s Cultural

Concert Review Assignment Example | Topics and Well Written Essays - 1000 words

Concert Review - Assignment Example The melody of the recital can be described by a short but fast shifting motive. The composer uses about four notes that the shift rapidly from one set to another. At the introduction and throughout the piece the energy and vigor depicted in the melody gives the recital a jovial or celebratory atmosphere and mood. The vigor and strength that is depicted in the piece can be likened to the mood of a carnival or an active musical dance. The harmony of the recital is also varied between an interval and a chord. In the introduction of the piece, the general harmony is an interval sounding at most two notes at a time. In the later stages of the piece, it shifts to a chord but turns back the harmony back to the interval. At the intervals, there is an underlying melody that supports the harmony. In the subsequent groups of chords, the melody is not very clear, and the progression is achieved in the recital. The variation between the interval and chords in the piece creates musical motion in t he presentation. Musically it is expected that where the interval is supported by an underlying melody and thee audience perceives a level of stability, the harmony is referred to as consonance. However, in the case of a turbulent and unstable set of chords, the harmony is referred to as a dissonance. The texture of this presentation can be described as both thick and thin. First, the texture can be described as monophonic. The description of the texture is because the presentation is a solo recital that is not accompanied by any vocals.