This article aritten by dr Eftekhari, has been published in main catalogue of ECNP 2015 in Amsterdam https://www.ecnp.eu/
Treatment in schizofrenia
Role of pharmacological treatment
Treatment of schizophrenia requires integration of medical, psychococial and psychological input. The bulk of care occurs in an outpatient setting and probably is best carried out by a multidisciplinary team, including some combination of the following: a psychopharmacologist, a counselor or therapist, a social worker, a nurse, a vocational counselor, and a case manager. Clinical pharmacists and internists can be valuable members of the team.
It is important not to neglect the medical care of the person with schizophrenia. Obesity, diabetes, cardiovascular disease, and lung diseases are prevalent in schizophrenia, and the person with schizophrenia often does not receive adequate medical care for such conditions.[78]
Antipsychotic medications (also known as neuroleptic medications or major tranquilizers) diminish the positive symptoms of schizophrenia and prevent relapses. Approximately 80% of patients relapse within 1 year if antipsychotic medications are stopped, whereas only 20% relapse if treated. Children, pregnant or breastfeeding women, and elderly patients present special challenges. In all of these cases, medications must be used with particular caution.
The choice of which drug to use for treatment of a patient with schizophrenia depends on many issues, including effectiveness, cost, side-effect burden, method of delivery, availability, and tolerability. Many studies have compared antipsychotic drugs with one another, but no broad consensus has been reached. In the absence of clinical or pharmacogenetic predictors of treatment response, the current treatment approach is largely one of trial and error across sequential medication choices.
Although treatment is primarily provided on an outpatient basis, patients with schizophrenia may require hospitalization for exacerbation of symptoms caused by noncompliance with pharmacotherapy, substance abuse, adverse effects or toxicity of medications, medical illness, psychosocial stress, or the waxing and waning of the illness itself. Hospitalizations are usually brief and are typically oriented towards crisis management or symptom stabilization.
Treatment of patients with schizophrenia, particularly during a psychotic episode, may raise the issue of informed consent. Consent is a legal term and should be used with respect to specific tasks. A person who is delusional in some but not all areas of life may still have the capacity to make medical and financial decisions.
I did a retrospective study in 4 inpatient clinics in Stockholm ,Sweden: My abstract which will be published and presented in 28th european congress in Amsterdam follows her:
Abstract, 28th ECNP Congress, 29 August-1 September 2015, Amsterda
Antipsychotic Treatment in Schizophrenia and related Psychosis,
Real life data analysis of Oral and Long Acting Antipsychotics
M. Eftekhari1, A. Berntsson2, Sverker Svensson3, J. Hjortsberg4, E. Jedenius5,6, L. Lundin7
1 Pavital Health Center, Stockholm, Sweden, 2 Adult Psychiatry PRIMA, Stockholm, Sweden, 3 Adult Psychiatric Clinic, Jämtland County Council, Sweden, 4 Adult Psychiatry, Dalarna County Council, Sweden, 5 Karolinska Institutet, NVS, Stockholm, Sweden, 6 Janssen-Cilag Nordic, 7 Psychosis Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
Keywords: Long acting antipsychotics, Antipsychotic Treatment in Schizophrenia and related Psychosis
Background
Antipsychotic medication is a cornerstone in the treatment of psychosis and in particular schizophrenia. In order to prevent relapse into psychotic episodes, long term treatment is advocated [1]. The pharmacological antipsychotic treatment can be administered orally or by intramuscular injections known as Long Acting Treatment (LAT). Moreover, adherence problems associated with the treatment of schizophrenia are common, increasing the risk of relapse and rehospitalisation [2]. The purpose of this study is, in a real life setting, to analyse the frequency of hospitalisations and compulsory psychiatric care during treatment with oral or LAT formulations.
Methods
A retrospective multicentre naturalistic approach was used to analyse real life data in a mirror-analysis. Twelve outpatient centres in Sweden were included, which mainly treat patients with schizophrenia and related psychoses. Consecutive patients were selected who had started and received at least one month’s antipsychotic drug treatment (Index Treatment) during the period from January 1st 2006 – December 31st 2007. No exclusion criteria were used. Data collection took place between March 2010 and March 2013, preventing interference from patients or medical personnel. Data from the two years leading up to the Index Treatment, and the following two years, was analysed for each patient. The primary endpoints were the frequency of hospitalisations or compulsory psychiatric care. The study was approved by an ethical committee and the patients’ identities were concealed from the data.
Results
In total 331 (52% women) patients were included, of which 22 patients were excluded from the analysis due to missing information. The average age of patients selected for oral treatment was 43 (range 17-74) years, and for LAT 50 (range 20-92) years. The most commonly used oral treatments (>10%) were aripiprazole, olanzapine and risperidone. The most commonly used LATs (>10%) were haloperidol, perphenazine, risperidone and zuclopenthixol. Fifty-two percent of the orally treated patients completed the two-year Index Treatment period, compared to 67% of the patients treated with LAT. The number of hospitalisations were reduced in both groups; oral from 1 to 0.89 (-11%) and LAT from 1.6 to 0.75 (-47%) admissions per patient. Further, episodes of compulsory psychiatric care also were reduced in both groups; oral from 0.34 to 0.27 (-21%) and LAT from 0.97 to 0.26 (-73%) episodes per patient.
Conclusions
The collected data in this setting shows that the patients selected for antipsychotic LAT were on average older and had historically greater frequency of both hospitalisations and compulsory psychiatric care, than those selected for oral treatment.
The initial differences in frequency of hospitalisations and compulsory psychiatric care seen between the two groups were no longer noticeable at the end of the Index Treatment.
Disclaimer: This project was supported by Janssen-Cilag Nordic with an unrestricted grant.
[1]Socialstyrelsen. Nationella riktlinjer för antipsykotisk läkemedelsbehandling vid schizofreni och liknande tillstånd. National Board of Social and welfare 2014:1-56.
[2]Morken G, Widen JH, Grawe RW. Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia. BMC psychiatry. 2008;8:32.
