Under‐utilized opportunities to optimize medication management in long‐term treatment of schizophrenia

Isohanni, Matti; Jääskeläinen, Erika; Moilanen, Jani; Hulkko, Anja; Huhtaniska, Sanna

doi:10.1002/wps.20523

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…The current status of treatment of schizophrenia remains pessimistic (Isohanni et al ., 2018), and early discovery is very important for the prevention and treatment of diseases. The overwhelming human and economic repercussions of mental illnesses make mental health reforms a worldwide priority.…”

Section: Discussionmentioning

confidence: 99%

Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017

Liu

et al. 2020

Epidemiol Psychiatr Sci

127

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Aim Schizophrenia is a serious health problem worldwide. This systematic analysis aims to quantify the burden of schizophrenia at the global, regional and national levels using the Global Burden of Disease Study 2017 (GBD 2017). Methods We collected detailed information on the number of incidence cases, disability-adjusted life years (DALYs) and age-standardised incidence rate (ASIR) and age-standardised rate of DALYs (ASDR) during 1990–2017 from GBD 2017. The estimated annual percentage changes (EAPCs) in the ASIR and in the ASDR were calculated to quantify the temporal trends in the ASIR and ASDR of schizophrenia. Results Globally there were 1.13 million (95% uncertainty interval [UI] = 1.00 to 1.28) incident schizophrenia cases and 12.66 million (95% UI = 9.48 to 15.56) DALYs due to schizophrenia in 2017. The global ASIR decreased slightly from 1990 to 2017 (EAPC = −0.124, 95% UI = −0.114 to −0.135), while the ASDR was stable. The number of incident cases, DALYs, ASIR and ASDR were higher for males than for females. The incident rate and DALYs rate were highest among those aged 20–29 and 30–54 years, respectively. ASIR and ASDR were highest in East Asia in 2017, at 19.66 (95% UI = 17.72 to 22.00) and 205.23 (95% UI = 153.13 to 253.34), respectively. In 2017, the ASIR was highest in countries with a high-moderate sociodemographic index (SDI) and the ASDR was highest in high-SDI countries. We also found that the EAPC in ASDR was negatively correlated with the ASDR in 1990 (P = 0.001, ρ = −0.23). Conclusion The global burden of schizophrenia remains large and continues to increase, thereby increasing the burden on health-care systems. The reported findings should be useful for resource allocation and health services planning for the increasing numbers of patients with schizophrenia in ageing societies.

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Section: Discussionmentioning

confidence: 99%

Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017

Liu

et al. 2020

Epidemiol Psychiatr Sci

127

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“…Moreover, only the French Association for Biological Psychiatry and Neuropsychopharmacology expert consensus guidelines propose LAIs to patients upon their first episode of psychosis and only after an adequate patient-informed consensus [ 29 ]. In the United States only 15–28% of patients with schizophrenia receive a LAI [ 30 , 31 ]. In Europe only 40% of clinicians would use LAIs for treating first-episode psychosis [ 32 ], while a large portion of them tend to use LAIs only in the case of patients with long-term disease and poor compliance [ 33 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review

et al. 2020

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Shared decision-making (SDM) is a process in which the doctor provides clear and complete medical information to patients about their treatment, and patients provide information on his/her preferences. Patients and clinicians bring different, but equally important, knowledge to the decision-making process. Through the adoption of SDM, it should be possible to overcome the barriers that hinder the acceptance of long-acting injectable antipsychotics (LAIs) by patients, and often also by psychiatrists. The present paper is a critical appraisal of recent literature on the impact of SDM in improving adherence to pharmacological treatments and in implementing the use of LAIs in the treatment of patients with schizophrenia. SDM is recognized as a promising strategy to improve collaboration between clinicians and patients in achieving recovery. When considering drug treatments, clinicians must evaluate the patient’s preferences, expectations and concerns towards the development of a personalized treatment strategy. Moreover, an active involvement in the decision process could reduce the patient’s perception of being coerced into the use of LAIs. Involving patients in the choice of therapy is not sufficient to increase pharmacological adherence if, at the same time, there is no constant work of comparison and communication with the reference psychiatric team. SDM can be particularly effective for LAI prescription, since patient can have prejudices and unjustified fears related to the LAI formulation, which the doctor must resolve.

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“…The aforementioned opinion has gained strong support from some renowned researchers who asserted the outweighed benefits of continuous antipsychotic treatment (31,32), but doubts were cast by those who valued adjunctive psychosocial intervention as just important as pharmacological intervention, voicing their concerns about potential dose-dependent adverse effects, impaired cognitive functioning, and even the toxic effect on the brain of long-term use of antipsychotics (33)(34)(35)(36)(37). Thus, the benefit of prevention from relapse by antipsychotics must be cautiously calibrated (38).…”

Section: Introductionmentioning

confidence: 99%

Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis

et al. 2021

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Background: Contradictory messages regarding the necessity of long-term antipsychotic treatment after first episode psychosis arouse deliberations in clinical practice. We explored if there is an alternative beyond the dichotomy of maintenance treatment and discontinuation of medications.Methods: We conducted a retrospective observational study by reviewing medical records at the study hospital of a cohort of patients since their participation in an early psychosis study starting from 2006, with special interests in patients able to maintain good functioning under treatment with a low antipsychotic dose.Results: Of the 81 patients with first-episode psychosis, 55 patients (67.9%) had follow-up information for longer than 5 years. The majority (n = 46, 83.6%) had non-affective psychosis, 20 patients (36.4%) had full-time employment/education by the time of their latest visit; among them, 15 patients received dosage of antipsychotics no more than the minimum effective dose [chlorpromazine equivalent (CPZE) dose, 200 mg/day]. Besides, 10 of 55 patients (18.2%) only received very low dose antipsychotics (CPZE < 50 mg/day) during maintenance, which was significantly correlated to good functioning. Being male, having a history of hospitalization, and being on clozapine therapy were correlated to poorer functioning. Antipsychotic-free status was achieved only in two non-psychotic patients.Conclusions: A substantial proportion of patients could achieve good functioning under low-dose antipsychotic maintenance after first-episode psychosis, even if they could not completely withdraw antipsychotics in the long term. Optimizing the balance between preventing relapse and preserving functioning by fine-tuning antipsychotic dosage during maintenance is a challenge warranting more clinical attention.

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Under‐utilized opportunities to optimize medication management in long‐term treatment of schizophrenia

Cited by 9 publications

References 8 publications

Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017

Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017

The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: a clinical review

Challenging the Minimum Effective Antipsychotic Dose During Maintenance: Implications From 10-Year Follow-Up of First Episode Psychosis

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