The treatment of schizophrenia: Can we raise the standard of care?

Catts, Stanley V.; O’Toole, Brian I.

doi:10.1177/0004867416672725

Cited by 32 publications

(26 citation statements)

References 84 publications

(108 reference statements)

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“…It remains then an important clinical treatment aim to reduce the risk of relapse as much as possible, for several reasons. Both the number [4,6,31–35] and total duration of subsequent relapses [36] have been linked with worsening of clinical indicators such as treatment resistance and is, for the patient, not conductive to continuous functioning nor autonomy [8,9,36–39]. One could therefore argue that any relapse delay is worth the effort from a clinical perspective, and also because it is known that relapses drive costs through hospitalization cost which is by far the major cost element of schizophrenia [9,40].…”

Section: Discussionmentioning

confidence: 99%

Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study

Decuypere¹,

Sermon

Geerts

et al. 2017

PLoS ONE

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Achieving greater continuation of treatment is a key element to improve treatment outcomes in schizophrenia patients. However, reported treatment continuation can differ markedly depending on the study design. In a retrospective setting, treatment continuation remains overall poor among patients using antipsychotics. This study aimed to document the difference in treatment continuation between four long-acting injectable antipsychotics based on the QuintilesIMS LRx databases, national, longitudinal, panel based prescription databases of retail pharmacies, in the Netherlands and Belgium. Paliperidone palmitate once monthly, risperidone microspheres, haloperidol decanoate, and olanzapine pamoate were studied. This study demonstrated significantly higher treatment continuation of paliperidone palmitate once monthly compared to risperidone microspheres (p-value<0,01) and haloperidol decanoate (p-value<0,01) in both countries, a significantly higher treatment continuation of paliperidone palmitate once monthly compared to olanzapine pamoate in the Netherlands (p-value<0,01), and a general trend towards better treatment continuation versus olanzapine pamoate in Belgium. Analysing the subgroup of patients without previous exposure to long-acting antipsychotic treatment revealed the positive impact of previous exposure on treatment continuation with a subsequent long acting treatment. Additionally, the probability of restarting the index therapy was higher among patients treated with paliperidone palmitate once monthly compared to patients treated with risperidone microspheres and haloperidol decanoate. The data source used and the methodology defined ensured for the first time a comparison of treatment continuation in a non-interventional study design for the four long-acting injectable antipsychotics studied.

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Section: Discussionmentioning

confidence: 99%

Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study

Decuypere¹,

Sermon

Geerts

et al. 2017

PLoS ONE

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“…Despite some important methodological limitations, it was additionally found that recovery and functional remission rates in the reduction/discontinuation group were twice those seen in the non‐dose reduction/discontinuation group. Importantly, the patients included in these trials had all experienced a clinical or functional remission that was sustained for six or 18 months (i.e., clinical stage 2).…”

Section: Early Intervention and Secondary/tertiary Preventionmentioning

confidence: 99%

“…In line with the clinical staging model, the retrospective diagnostic stability was low for both spectra (0.60), indicating that many first-episode patients who receive a non-specific diagnosis of psychosis (e.g., psychosis not otherwise specified) will eventually develop schizophrenia or affective psychoses 135 . Therefore, having a baseline diagnosis of schizophrenia spectrum or affective spectrum psychotic disorder may still have significant clinical impacts 136 .…”

Section: For How Long Should Early Intervention Services Be Offered?mentioning

confidence: 99%

Improving outcomes of first‐episode psychosis: an overview

2017

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Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders.

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“…It is a chronic, often disabling illness that affects approximately 24 million people worldwide 3 . In the 1970s, the standardized mortality rate of schizophrenia was 1.84-fold more than that of the general population, which increased to 3.20-fold in 1990s and the trend has continued into the last decade 4 . Although antipsychotic treatment such as clozapine may ameliorate schizophrenia symptoms, approximately 20% to 30% of schizophrenia patients fail to respond to pharmacotherapy despite their adherence 5 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Traditional Chinese Medicineas as an Adjunct Therapy for Refractory Schizophrenia: A Systematic Review and Meta Analysis

Wei

Lin

Zhang

et al. 2018

Sci Rep

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Although recent studies focused on traditional Chinese medicine (TCM) for the treatment of refractory schizophrenia have reported that it may be beneficial, there is still lack of convincing evidence and critical meta-analytic work regarding its effectiveness as an adjunctive therapy. Therefore, we performed a meta-analysis to investigate the effectiveness of TCM in combination with antipsychotics for refractory schizophrenia. Fourteen articles involving 1725 patients published as of December 2016 were included which compared antipsychotic therapies to either TCM alone, or TCM as an adjunctive therapy. TCM was observed to have beneficial effects on aspects of the Positive and Negative Syndrome Scale (PANSS) including total score changes and negative score changes, as well as clinical effects estimated with PANSS or the Brief Psychiatric Rating Scale (BPRS). The changes in extrapyramidal side effects (RSESE) scores from baseline to the end of the treatment period were similar in two groups of related trials. TCM was also reported to mitigate some anti-psychotic related side-effects and overall, TCM adjuvant therapy was generally safe and well tolerated. While, the results indicated the potential utility of TCM as an alternative adjunctive therapeutic for refractory schizophrenia treatment, there remains a need for further high-quality studies.

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The treatment of schizophrenia: Can we raise the standard of care?

Abstract: There is an urgent need to re-engineer the early management of schizophrenia and to routinely evaluate this type of innovation within practice-based research networks. A proposal for an assertive treatment algorithm is included.

Cited by 32 publications

References 84 publications

Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study

Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study

Improving outcomes of first‐episode psychosis: an overview

Effectiveness of Traditional Chinese Medicineas as an Adjunct Therapy for Refractory Schizophrenia: A Systematic Review and Meta Analysis

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