[Prodromes of schizophrenia recurrence].
Service de Psychiatrie Générale de Martigues 13G24, Hôpital du Vallon, BP 248, Centre Hospitalier de Martigues, 13698 Martigues cedex. L Encéphale
(Impact Factor: 0.7).
01/2009; 35 Suppl 1:S33-40.
Schizophrenic disorders are chronic disorders usually characterized by relapses alternating with periods of remission. A better understanding of the course of schizophrenic disorders is available with the models of psychotic vulnerability and the neurodevelopmental hypothesis. The relapses have numerous severe aspects, clinical, biological and conduct to a bad prognosis. A relapse prevention constitutes a major issue in regard of public health. A relapse prevention is possible with identification of relapse prodromal signs (or early signs of relapse). The relapse prodromal signs are often aspecific but remain stable in each patient. These relapse prodromal signs are similar to the initial prodromal signs, as well as in symptomatology than as their chronologic apparition. Specific psychoeducation strategy allows for each patient to learn its own stressful events and its own prodromal signs of relapse, as well as onset of each prodromal symptoms. A pilot study conducts to a psychoeducative program of relapse prevention centered on learning about prodromal symptoms and validation of a relapse prodromal signs questionnaire.
Available from: Michiel E Hemels
- "Potential drivers of relapse. Adherence problems [2,6,7,13,17,25,26,31],[34,45,47,53,57,76,85,100-105]; stress, depression, depressive symptoms, neurosis [2,6,7,12,55,59,70,97],[106-108]; substance abuse [2,6,7,21,31,57,59,83],; lifestyle factors [7,12,21,38,79,109,110]; hospitalization or relapse history [21,31,38,40,57,59,97]; treatment-related issues [6,7,28,43,61,70,111]; treatment interruption or delay [2,6,12,75,85,112,113]; disease-related factors [57,70,83,85,97,114]; quetiapine, anticholinergics, mood stabilizers (MS), oral neuroleptics, anxiolytics or hypnotics [21,31,51,55]; male gender [30,37,83,115]; use of first-generation antipsychotics (FGA) vs second-generation antipsychotics (SGA) [30,85,116]; outpatient vs inpatient [29,39]; poor patient insight [20,83]; younger age [57,83]; generic vs branded medication ; reduced compliance/family involvement in Information Technology Aided Relapse Prevention in Schizophrenia (ITAREPS) programme ; depot antipsychotics . "
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ABSTRACT: Relapse in patients with schizophrenia has devastating repercussions, including worsening symptoms, impaired functioning, cognitive deterioration and reduced quality of life. This progressive decline exacerbates the burden of illness on patients and their families. Relapse prevention is identified as a key therapeutic aim; however, the absence of widely accepted relapse definition criteria considerably hampers achieving this goal. We conducted a literature review in order to investigate the reporting of relapses and the validity of hospitalization as a proxy for relapse in patients with schizophrenia. The primary aim was to assess the range and validity of methods used to define relapse in observational or naturalistic settings. The secondary aim was to capture information on factors that predicted or influenced the risk of relapse. A structured search of the PubMed database identified articles that discussed relapse, and hospitalization as a proxy of relapse, in patients with schizophrenia. National and international guidelines were also reviewed. Of the 150 publications and guidelines identified, 87 defined relapse and 62% of these discussed hospitalization. Where hospitalization was discussed, this was as a proxy for, or a component of, relapse in the majority of cases. However, hospitalization duration and type varied and were not always well defined. Scales were used to define relapse in 53 instances; 10 different scales were used and multiple scales often appeared within the same definition. There were 95 references to factors that may drive relapse, including non-adherence to antipsychotic medication (21/95), stress/depression (11/95) and substance abuse (9/95). Twenty-five publications discussed the potential of antipsychotic therapy to reduce relapse rates---continuous antipsychotic therapy was associated with reduced frequency and duration of hospitalization. Non-pharmacological interventions, such as psychoeducation and cognitive behavioural therapy, were also commonly reported as factors that may reduce relapse. In conclusion, this review identified numerous factors used to define relapse. Hospitalization was the factor most frequently used and represents a useful proxy for relapse when reporting in a naturalistic setting. Several factors were reported to increase the risk of relapse, and observation of these may aid the identification of at-risk patients.
Available from: Klara Latalova
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ABSTRACT: Psychoeducation programs have been shown in the last two decades to significantly improve the post-hospital discharge care of individuals with schizophrenia by demonstrated effects on rehospitalization rates, compliance with medication and knowledge. The benefits of psychoeducation can be sustained for up to seven years although most studies have not shown such enduring benefit. Psychoeducation is a type of psychotherapeutic support that aims to provide broad and adequate information on psychotic disorders for both patients and their families.
The purpose of the group psychoeducational program at the Psychiatric clinic in Olomouc is to familiarize patients with the core of the disorder, explain the part played by pharmacotherapy, teach recognition of the warning signs of relapse, to advise on communication problems within families, and finally the training of social skills.
Patients perceive the program as meaningful and helpful in better understanding their lives.
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