Reasoning about the optimal duration of prophylactic antipsychotic medication in schizophrenia: evidence and arguments

Haandel, L. J. M. Bosveld-van; Slooff, C. J.; Bosch, R. J. Van Den

doi:10.1034/j.1600-0447.2001.00089.x

Cited by 33 publications

(13 citation statements)

References 67 publications

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“…Importantly, the risk of relapse was relatively stable during the 3-year follow-up period, indicating that, despite achieving remission, treatment of schizophrenia must be maintained long-term. 22 We found that duration of illness influenced both remission and relapse: a longer duration of illness was associated with a lower risk of remission and of relapse. These results confirm that schizophrenia, over the long-term, tends to have a deteriorating course in which remission is more and more infrequent, but also that patients with schizophrenia have fewer and less severe relapses.…”

Section: Discussionmentioning

confidence: 94%

Remission and Relapse in the Outpatient Care of Schizophrenia

Haro

Novick²,

Suarez

et al. 2006

Journal of Clinical Psychopharmacology

118

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Remission and relapse are clinical outcomes of increasing interest in schizophrenia. We analyzed remission and relapse, and the sociodemographic and clinical factors associated with these outcomes, in the usual care of schizophrenia using the 3-year, follow-up data from a large cohort of outpatients with schizophrenia taking part in the prospective, observational, European Schizophrenia Outpatient Health Outcomes study. Of the 6516 patients analyzed for remission, 4206 (64.6%) achieved remission during the 3-year, follow-up period. Logistic regression analysis revealed that being female, having a good level of social functioning at study entry, and a shorter duration of illness were factors significantly associated with achieving remission. Treatment with olanzapine was also associated with a higher frequency of remission compared with other antipsychotic agents. A Kaplan-Meier survival curve estimated that relapse occurred in approximately 25% of the patients who achieved remission, with the risk of relapse remaining constant during the follow-up period. Shorter duration of illness, having hostile behaviors, and substance abuse were factors associated with a higher risk of relapse, whereas good level of social functioning and the use of olanzapine and clozapine were associated with a lower risk of relapse. In conclusion, the 3-year results of the Schizophrenia Outpatient Health Outcomes study indicate that the likelihood of remission decreases over the longitudinal course of schizophrenia, but risk of relapse is maintained even after 3 years of achieving remission severity levels. Results suggest that treatment with olanzapine is associated with a better chance of achieving remission than other antipsychotics. Moreover, the use of olanzapine and clozapine is associated with a lower risk of relapse compared with risperidone, quetiapine, and typical antipsychotics. The results should be interpreted conservatively because of the observational, nonrandomized study design.

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Section: Discussionmentioning

confidence: 94%

Remission and Relapse in the Outpatient Care of Schizophrenia

Haro

Novick²,

Suarez

et al. 2006

Journal of Clinical Psychopharmacology

118

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“…Better treatment adherence could have an impact on reducing the frequency of relapses (Kane et al, 1998) which may, in turn, reduce the cost of treatment by reducing the length of hospitalization with concomitant improvement in the overall disability in these patients (Knapp et al, 2002;Patel et al, 2003). However, not all the depot antipsychotics are equally effective (Coutinho et al, 2000;Quraishi and David, 2001) and there is some evidence suggesting that the relapses may be unpredictable even with depot maintenance treatment (Bosveld-van Haandel et al, 2001).…”

Section: Discussionmentioning

confidence: 96%

Depot antipsychotic use in schizophrenia: an East Asian perspective

Sim

Ungvári

et al. 2004

Human Psychopharmacology

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“…The most important interventions for first episode psychosis are: accurate diagnostic assessment, initiating antipsychotic medication as soon as it is feasible, and continuation of antipsychotic treatment after response for at least one year in the APA guidelines and at least two years in the Dutch guidelines. The recommended duration of antipsychotic prophylaxis in the Dutch guidelines is one year longer, because relapse rates do not seem to level off during the first years after remission from a first episode [17]. …”

Section: Introductionmentioning

confidence: 99%

Detection of psychosis by mental health care services; a naturalistic cohort study

Boonstra

Wunderink

Sytema

et al. 2008

Clinical Practice and Epidemiology in Mental Health

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BackgroundDetection of psychotic disorders is an important issue, since early treatment might improve prognosis. Timely diagnosis of psychotic disorders depends on recognition of psychotic symptoms and their interpretation. The aim of this study is to examine to what extent reported psychotic symptoms are accounted for in clinical diagnosis.MethodsThe medical files of all patients who had a first contact with one of two mental health care services (N = 6477) were screened for reported psychotic symptoms and subsequent clinical diagnosis. Patients who reported psychotic symptoms and who were diagnosed with a psychotic disorder were followed-up for two years to register prescription of antipsychotic treatment and continuity of care.ResultsIn the files of 242 (3.7%) patients specific psychotic symptoms were recorded. 37% of these patients were diagnosed with a non-affective psychotic disorder, 7% with other psychotic disorders and 56% with non-psychotic disorders or no diagnosis at all. About 90% of the patients diagnosed with a psychotic disorder did receive any prescription of antipsychotics, and about 50% were in continuous care during the first 2 years.ConclusionRelatively large proportions of patients presenting with psychotic symptoms were diagnosed with a non-psychotic diagnosis or not diagnosed at all. This applies also to patients reporting at least two or more psychotic symptoms. Although we did not verify the appropriateness of clinical diagnosis, these findings are an indication that psychotic disorders may be underdetected. Improving the diagnostic process in mental health care services may be the most obvious way to promote early intervention in psychosis.

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Reasoning about the optimal duration of prophylactic antipsychotic medication in schizophrenia: evidence and arguments

Cited by 33 publications

References 67 publications

Remission and Relapse in the Outpatient Care of Schizophrenia

Remission and Relapse in the Outpatient Care of Schizophrenia

Depot antipsychotic use in schizophrenia: an East Asian perspective

Detection of psychosis by mental health care services; a naturalistic cohort study

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