Towards a framework for treatment effectiveness in schizophrenia

Abstract

IntroductionPrompt administration of antipsychotic treatment that is adhered to is essential for the optimal treatment of schizophrenia. Many patients have benefited from the advent of second-generation antipsychotics, which can offer good symptomatic control with reduced incidence of extrapyramidal symptoms, although with higher risk of metabolic side effects. It is unsurprising that accounts as to whether first- and second-generation antipsychotics differ in their efficacy vary, since treatment effectiveness is a broad notion and difficult to define.ObjectivesNumerous factors may be used to gauge treatment effectiveness and, while it has largely been defined in terms of improvements in four domains (symptoms of disease, treatment burden, disease burden, and health and wellness), the real-world clinical utility of this consensus is unclear. Therefore, this article aims to provide a framework that can aid psychiatrists in making assessments about treatment effectiveness.Methods and resultsA panel of 12 psychiatrists and psychopharmacologists convened to develop and propose an accessible and globally-applicable framework for assessing the effectiveness of antipsychotic treatments in patients with schizophrenia. Following presentation of a preliminary proposal to a wider group of psychiatrists from across Europe, it was refined into a framework comprising five domains: symptomatic remission and retention of treatment; affective symptoms; cognitive functioning; treatment satisfaction; and personal and social functioning – each of which is discussed in this article.ConclusionsThis article provides a framework that can aid psychiatrists in making assessments about treatment effectiveness. It is anticipated that the framework outlined here may contribute to improving clinical practice through the promotion of a patient-centered approach to the assessment of treatment effectiveness, using five specified domains, in patients with schizophrenia.

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“…Satisfaction with and preference for RBP-7000 are important considerations since treatment satisfaction is a crucial component of long-term outcomes. For example, a panel of 12 psychiatrists discussed treatment satisfaction as an important domain for treatment effectiveness and retention in patients with schizophrenia39 and patient satisfaction has been associated with improvement in long-term outcomes in schizophrenia 6. Patient satisfaction has also been shown to be correlated with treatment retention in a non-schizophrenic population 40…”

<p>The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia</p>

“…Treatment satisfaction correlates positively with adherence to therapy,60 and several domains of treatment satisfaction have been associated with the type and mode of medication delivery. These include perceived effectiveness, side effects, ease of treatment regimen, and costs 61,62.…”

<p>A commentary on the efficacy of olanzapine for the treatment of schizophrenia: the past, present, and future</p>

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