Maximizing the synergy between pharmacotherapy and psychosocial therapies for schizophrenia

Lenroot, Rhoshel; Bustillo, Juan

doi:10.1016/s0193-953x(02)00017-5

Cited by 31 publications

(9 citation statements)

References 64 publications

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“…[53] An integrated approach using several psychosocial modalities is regarded as standard practice in treating patients with schizophrenia. [54–56] One 2-year trial, which compared an integrated biomedical/psychosocial treatment with standard pharmacotherapy and case management in patients with recent-onset schizophrenia, has also supported the use of integrated care as a way to improve outcomes, including positive and negative symptom outcomes. [57] Other approaches include supportive employment, family intervention, psychoeducation, assertive community treatment, social skills training and cognitive behavioural treatment; the latter appears to improve insight, positive symptoms and depressive symptoms and also suicidal behaviour.…”

Section: Psychosocial Modalitiesmentioning

confidence: 99%

Managing Suicide Risk in Patients with Schizophrenia

2011

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The management of suicide risk in patients with schizophrenia poses many challenges for clinicians. Compared with the general population, these patients have an 8.5-fold greater risk of suicide. This article reviews the literature dealing with the treatment of at-risk patients with schizophrenia. An integrated psychosocial and pharmacological approach to managing this population of patients is recommended. Although there is at least modest evidence suggesting that antipsychotic medications protect against suicidal risk, the evidence appears to be most favourable for second-generation antipsychotics, particularly clozapine, which is the only medication approved by the US FDA for preventing suicide in patients with schizophrenia. In addition, treating depressive symptoms in patients with schizophrenia is an important component of suicide risk reduction. While selective serotonin receptor inhibitors (SSRIs) ameliorate depressive symptoms in patients with schizophrenia, they also appear to attenuate suicidal thoughts. Further research is needed to more effectively personalize the treatment of suicidal thoughts and behaviours and the prevention of suicide in patients with schizophrenia.

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Section: Psychosocial Modalitiesmentioning

confidence: 99%

Managing Suicide Risk in Patients with Schizophrenia

2011

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“…This is because such impairment often results in difficulties in activities of daily living as well as poor interpersonal relationships; and in turn, contributes to low levels of productivity with high rates of unemployment among others [4][5][6]. Despite the striking nature of the psychotic symptoms of schizophrenia, impairments with its associated problems are more relevant in the expression of its economic costs [7].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Functioning among Nigerians with Schizophrenia in a Tertiary Health Facility: Influence of Psychopathology, Socio-demographic and Treatment Factors

Campbell

Olagunju

Aina

et al. 2015

J. Psychosoc. Rehabil. Ment. Health

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To investigate the profile of functional impairment and the influence of psychopathology with other determinants among individuals with schizophrenia in a Nigerian tertiary health facility. The study participants consisted of one hundred adults with schizophrenia. Eligible participants were recruited using systematic random sampling technique. All participants were interviewed with questionnaire to elicit socio-demographic and treatment related information. This was followed by interview with brief psychiatric rating scale (BPRS) and the global assessment of functioning (GAF) to assess for psychopathology and impairment in functioning respectively. Analyses of data were done using SPSS-16. The mean age of the participants was 33.87(±11.6) years and a little above half (52 %) of the participants were female. Sixty (60 %) subjects had active psychopathology using BPRS cut-off score of [10; while participants with duration of illness of more than 10 years (X 2 = 5.59, p = 0.018) and previous relapse (X 2 = 6.34, p = 0.012) were more likely to have psychopathology. Overall, a little over two-thirds (69 %) had impairment following administration of GAF. Mild impairment was observed in 23 % of the participants, moderate impairment in 19 and up to 18 % of participants had severe impairment due to psychopathology. Subjects with lesser education, duration of illness of more than 10 years, extrapyramidal side effects (EPSE), previous relapse and psychopathology had significant levels of impairment (p \ 0.05). However, it was education (Odds ratio [OR] = 0.060; 95 % Confidence interval [95 % CI] = 0.055, 0.770; p = 0.031), psychopathology (OR 5.265; 95 % CI 2.744, 13.626; p \ 0.001) and EPSE (OR 0.183; 95 % CI 0.049, 0.939; p = 0.043) that were independently associated with impairment in functioning following logistic regression to control for effects of confounders. In this study, varied degrees of impairment in functioning were prevalent among individuals with schizophrenia under treatment. However, those with lesser education, EPSE, active psychopathology and longer duration of illness were more likely to be impaired. Thus, better attention to the management of active psychopathology and prevention of extra-pyramidal side effects are indicated in order to promote improve functioning in schizophrenia. In addition, promotion of recovery oriented psychosocial services with need-based rehabilitation program for individuals with schizophrenia is advocated. There is need for more research on predictors of functioning towards promotion of evidence based rehabilitation.

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“…Tan sólo el 25,3% está en situación laboral activa (dato concordante con los estudios de Lauriello y cols. que cifra la tasa de empleo en enfermos mentales crónicos es del orden del 20% 190 ). Al considerar su situación civil el 68% se encuentran solteros, lo que pone de manifiesto las dificultades en el desarrollo de una vida social, afectiva y relacional completa.…”

Section: Discusión 9 Discusiónunclassified

Factores determinantes del riesgo metabólico en el tratamiento con antipsicóticos atípicos

Pato¹,

Rodríguez²,

Valverde³

2016

Psiquiatría Biológica

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Desde hace años se ha constatado que la esquizofrenia y otros trastornos psicóticos se asocian a elevadas tasas de morbimortalidad. Las causas de este incremento van desde las asociadas al uso de tratamientos específicos para esta enfermedad como a factores de salud relacionados con dicho proceso.Las principales causas de muerte en personas con enfermedad mental grave son similares a las observadas en la población general. Así, en la población general, la enfermedad cardiovascular es la principal causa de mortalidad y dicha mortalidad se ha reducido en los últimos años debido a las mejoras tratamientos y a las iniciativas de salud pública. Sin embargo, la enfermedad cardiovascular aún es alta en personas con enfermedad mental grave y en ellas no se ha visto esta reducción 1 .Los pacientes con esquizofrenia tienen una esperanza de vida un 20% menor que la población general, calculándose que mueren una media de 25 años antes 2 . Se calcula un riesgo relativo de 7,5 veces superior a la población general para la mortalidad por causas no naturales, como suicidio o muerte accidental (40% de las muertes prematuras en estos pacientes); y de 2,41 veces para la mortalidad por causas naturales, especialmente enfermedades cardiovasculares, infecciosas, respiratorias, y endocrinas 3 (60% de las muertes prematuras en estos pacientes) calculándose una mortalidad general 2-3 veces superior que en la población general 4 .En estudios que abordan específicamente las causas de muerte en la esquizofrenia frente a la población general establecen las siguientes cifras: un riesgo 2,7 veces mayor en la diabetes, un riesgo 2,3 veces mayor para enfermedades cardiovasculares, un riesgo de 3,2 veces mayor para las enfermedades respiratorias y de un 3,4 para enfermedades infecciosas 5 .En general, la mayor mortalidad cardiovascular asociada a la esquizofrenia, la depresión unipolar y el trastorno bipolar se atribuye a un riesgo relativo a presentar factores de riesgo modificables de enfermedad cardiovascular de 1 a 5 veces superior al del resto de la población 6 , tal y como se aprecia en la tabla 1.

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Maximizing the synergy between pharmacotherapy and psychosocial therapies for schizophrenia

Cited by 31 publications

References 64 publications

Managing Suicide Risk in Patients with Schizophrenia

Managing Suicide Risk in Patients with Schizophrenia

Assessment of Functioning among Nigerians with Schizophrenia in a Tertiary Health Facility: Influence of Psychopathology, Socio-demographic and Treatment Factors

Factores determinantes del riesgo metabólico en el tratamiento con antipsicóticos atípicos

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