Relapse prevention and recovery in the treatment of schizophrenia

Department of Psychiatry, Georgetown University School of Medicine, 3800 Reservoir Road NW, Washington, DC 20007, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 02/2006; 67 Suppl 5:19-23.
Source: PubMed


Nonadherence to medication is a predictor of relapse in patients diagnosed with schizophrenia, and preventing relapse is crucial to achieving the goal of recovery. Long-term treatment with antipsychotics can be effective, although long-term patient response to medication may be difficult to predict from trials that measure response, remission, and relapse rates because they are often too short. Longer trials are needed to fully understand the implications of adherence and symptom remission in patient outcome. Recovery, however, is contingent on the stabilization of the symptoms of schizophrenia and the acquisition of the skills necessary to function in society. Psychosocial interventions, such as family psychoeducation, social skills training, and cognitive-behavioral therapy, used in conjunction with pharmacotherapy are effective in helping to prevent symptom relapse and promote functional recovery in patients with schizophrenia.

4 Reads
  • Source
    • "While both olanzapine treatments were similarly efficacious , measured by CGI-S, GAF and SWN, significant differences in patient compliance between groups were revealed. Poor adherence to antipsychotic medication has been associated with outcomes including relapse and rehospitalization (Schooler, 2006; Morken et al., 2008). Supporting the results of a study by Kinon and colleagues (2003) in acutely ill noncompliant patients, this study suggests that ODO may help improve compliance, which also should improve overall treatment benefits (Canadian Psychiatric Association, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients with schizophrenia and bipolar disorder have frequently reported weight gain during olanzapine treatment. Previous studies have observed a decrease in weight gain, or weight loss, in patients switching from standard olanzapine tablets (SOT) to orally disintegrating olanzapine (ODO) tablets. The primary objective of this study was to investigate the change in body mass index (BMI) in patients who had previously gained weight with SOT and continued with this therapy during the study period, compared with those patients who switched to ODO during the study period. This was a 16-week, multicentre, randomized, double-blind, double-dummy, study of outpatients diagnosed with schizophrenia, schizoaffective disorder, related psychotic disorder or bipolar disorder, who were taking 5-20 mg SOT daily. Patients continued treatment with 5-20 mg olanzapine in a flexible single daily dose, and were randomized to either receive sublingual ODO plus an oral placebo, or sublingual placebo plus SOT. No statistically significant between group differences in mean change from baseline in BMI, weight or waist circumference were observed. Analysis of change in body weight from baseline, by pre-specified category (no change, loss of >or=1.5 kg, gain of >or=1.5 kg), revealed a significant difference between groups, favoring ODO patients, who also experienced a significant reduction in subjective appetite and better treatment compliance, compared to patients in the SOT group. In this study, patients treated with ODO experienced a similar mean change in BMI and weight from baseline, to those patients treated with SOT.
    Schizophrenia Research 06/2009; 113(1):41-8. DOI:10.1016/j.schres.2009.05.024 · 3.92 Impact Factor
  • Source
    • "It has been showed in several studies that perception of cognitive impairments is a common subjective experience in schizophrenia even if cognitive self-reports appears to be inconsistent with objective cognitive results [30,31,40]. If objective cognitive testing is an important predictor of the course of schizophrenia, assessment of subjective illness perceptions may be useful in predicting treatment compliance and therapeutic alliance [20] especially in mental disorder with a high risk of relapses [26] [43]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Whereas new pharmacological treatments are developed for cognitive impairments in schizophrenia, self-assessment of cognitive dysfunctioning besides their objective validity could be of interest in evaluating patients' motivation to engage in rehabilitation program. Nevertheless insight into symptoms is severely impaired in schizophrenia and is negatively linked with poor compliance. But it is yet unknown if patients with poor insight into their symptoms could have some insight into their cognitive impairments. The aim of this study was to explore the relationships existing between the cognitive complaint and the level of awareness of the disease in patients with schizophrenia. A total of 101 patients with DSM-IV schizophrenia or schizoaffective disorder and 60 control participants were recruited. Insight was assessed using the Scale to assess Unawareness of Mental Disorder (SUMD) and cognitive complaint intensity was assessed with the Scale to Investigate Cognition in Schizophrenia (SSTICS). Participants with schizophrenia displayed the same level of cognitive complaint when compared to healthy controls. Strong correlations were observed between SSTICS total score and duration of illness, levels of depression and state anxiety. Patients with a good insight into the therapeutic effects achieved with medication expressed a more important cognitive complaint. No correlations were found between the four others SUMD insight dimensions and total SSTICS score. The partial overlap of insight into illness and cognitive complaint suggests that insight is modular in schizophrenia. Assessment of cognitive complaint and awareness of illness need to be assessed before engagement in rehabilitation program.
    European Psychiatry 04/2009; 24(4):251-8. DOI:10.1016/j.eurpsy.2008.12.010 · 3.44 Impact Factor
  • Source
    • "The Schizophrenia Patient Outcomes Research Team (PORT) recommendations support chronic maintenance antipsychotic treatment (Lehman et al. 2004; Lehman et al. 1998). This results in fewer symptoms, a less episodic course (APA 1997), better clinical and functional outcomes for adults with schizophrenia (Lehman et al. 1995; Verdoux et al. 2000), and fewer relapses (Herz et al. 1991; Schooler 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To characterize the longitudinal patterns of antipsychotic treatment and to investigate the relationship between antipsychotic treatment patterns and acute hospitalizations among adults with schizophrenia. We hypothesized that continuous antipsychotic treatment would be associated with fewer hospitalizations and shorter lengths of stay. Seven years of retrospective Maryland Medicaid administrative data were used to examine inpatient medical encounters and outpatient psychotropic treatment in community-based settings from 1993 through 2000. The sample consisted of 1727 adults continuously enrolled in the Maryland Medicaid program from July 1992 through June 1994, and diagnosed with schizophrenia. The main outcome measures were a) any schizophrenia hospitalization; b) number of schizophrenia hospitalizations; and c) inpatient days associated with a primary diagnosis of schizophrenia. The average duration of antipsychotic use was six months in any single year and four and one-half years across the entire study period. Compared to individuals with a more continuous pattern of antipsychotic treatment, individuals with moderate or light use had odds of hospitalization for schizophrenia that were 52 or 72% greater (95%CI: 30-75% greater, 49-100% greater respectively). Light users of antipsychotics have an average length of stay per hospitalization that is approximately 20% longer than the average for continuous users (95%CI: 2-39% longer). Findings emphasize the benefit of continuous antipsychotic treatment for individuals with schizophrenia.
    Schizophrenia Research 05/2008; 101(1-3):304-11. DOI:10.1016/j.schres.2007.12.475 · 3.92 Impact Factor
Show more