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Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe

Published online by Cambridge University Press:  16 April 2020

G. Papageorgiou ,
F. Cañas ,
M. Zink  and
A. Rossi
G. Papageorgiou*
Affiliation:
Department of Psychiatry, Evangelismos General Hospital, 45 Ypsilandou str. GR-106 76, Athens, Greece
F. Cañas
Affiliation:
Hospital Dr. Rodríguez Lafora, Department of Psychiatry, Cra. De Colmenar Viejo km 13,8, Madrid, Spain
M. Zink
Affiliation:
Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Mannheim, Germany
A. Rossi
Affiliation:
Section of Neurosciences, Department of Experimental Medicine, University of L’Aquila, L’Aquila, Italy
*
*Corresponding author. Tel.: +30 (210) 810 4410. E-mail address:[email protected]
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Abstract

Schizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family (versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.

Keywords

SchizophreniaCountry differencesAntipsychoticsPatient subgroupsPatient characteristicsHealth provisionComorbidities
Type
Research Article
Information
European Psychiatry , Volume 26 , Issue S1: Patients with schizophrenia: Results of a physician-based survey conducted in four European countries (Germany, Greece, Italy and Spain) , March 2011 , pp. 17 - 28
Copyright
Copyright © European Psychiatric Association 2011

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References

Jablensky, A.Sartorius, N.Ernberg, G.Anker, M.Korten, A.Cooper, J.E.Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study Psychol Med Monogr Suppl 20 1992 1–97Google ScholarPubMed
Saha, S.Chant, D.Welham, J.McGrath, J.A systematic review of the prevalence of schizophrenia PLoS Med 2 2005 e141CrossRefGoogle ScholarPubMed
McGrath, J.Saha, S.Chant, D.Welham, J.Schizophrenia: a concise overview of incidence, prevalence, and mortality Epidemiol Rev 30 2008 67–76CrossRefGoogle Scholar
Hafner, H.Maurer, K.Loffler, W.Riecher-Rossler, A.The influence of age and sex on the onset and early course of schizophrenia Br J Psychiatry 162 1993 80–86CrossRefGoogle ScholarPubMed
Loranger, A.W.Sex difference in age at onset of schizophrenia Arch Gen Psychiatry 41 1984 157–161CrossRefGoogle ScholarPubMed
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 4th edn. 2000 American Psychiatric Association Washington DC Text RevisionGoogle Scholar
World Health Organisation. International Statistical Classification of Diseases and Related Health Problems 10th Revision. 2007.Google Scholar
Remington, G.Foussias, G.Agid, O.Progress in defining optimal treatment outcome in schizophrenia CNS Drugs 24 2010 9–20CrossRefGoogle Scholar
Lieberman, J.A.Stroup, T.S.McEvoy, J.P.Swartz, M.S.Rosenheck, R.A.Perkins, D.O.Effectiveness of antipsychotic drugs in patients with chronic schizophrenia N Engl J Med 353 2005 1209–1223CrossRefGoogle ScholarPubMed
Correll, C.U.Canas, F.Larmo, I.Levy, P.Montes, J.M.Fagiolini, A.Individualizing antipsychotic treatment selection in schizophrenia: characteristics of empirically derived patient subgroups Eur Psychiatry 26 2011 3–16CrossRefGoogle ScholarPubMed
Abel, K.M.Drake, R.Goldstein, J.M.Sex differences in schizophrenia Int Rev Psychiatry 22 2010 417–428CrossRefGoogle Scholar
Organisation for Economoc Co-operation and Developmen. OECD Health Data 2010: Statistics and Indicators. 2010.Google Scholar
World Health Organisation Mental Health Atlas 2005 WHO GenevaGoogle Scholar
Becker, T.Knapp, M.Knudsen, H.C.Schene, A.Tansella, M.Thornicroft, G.The EPSILON Study – a study of care for people with schizophrenia in five European centres World Psychiatry 1 2002 45–47Google ScholarPubMed
Saz-Parkinson Z, Medel A, Cediel-Garcia P, Castellote J, Bouza C, Amate JM. Trends on schizophrenia admissions during the deinstitutionalisation process in Spain (1980–2004). Soc Psychiatry Psychiatr Epidemiol 2010 [In press].CrossRefGoogle Scholar
Vazquez-Barquero, J.L.Garcia, J.Deinstitutionalization and psychiatric reform in Spain Eur Arch Psychiatry Clin Neurosci 249 1999 128–135CrossRefGoogle ScholarPubMed
Brown, S.Kim, M.Mitchell, C.Inskip, H.Twenty-five year mortality of a community cohort with schizophrenia Br J Psychiatry 196 2010 116–121CrossRefGoogle ScholarPubMed
Correll, C.U.Frederickson, A.M.Kane, J.M.Manu, P.Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophr Res 89 2007 91–100CrossRefGoogle ScholarPubMed
Kohn, R.Saxena, S.Levav, I.Saraceno, B.The treatment gap in mental health care Bull World Health Organ 82 2004 858–866Google ScholarPubMed
De Hert, M.Dekker, J.M.Wood, D.Kahl, K.G.Holt, R.I.Moller, H.J.Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) Eur Psychiatry 24 2009 412–424CrossRefGoogle Scholar
De Hert, M.Mauri, M.Shaw, K.Wetterling, T.Doble, A.Giudicelli, A.The METEOR study of diabetes and other metabolic disorders in patients with schizophrenia treated with antipsychotic drugs. I. Methodology Int J Methods Psychiatr Res 19 2010 195–210CrossRefGoogle ScholarPubMed
World Health Organisation. Global Database on Body Mass Index. 2010.Google Scholar
Holt, R.I.Peveler, R.C.Obesity, serious mental illness and antipsychotic drugs Diabetes Obes Metab 11 2009 665–679CrossRefGoogle ScholarPubMed
Enger, C.Weatherby, L.Reynolds, R.F.Glasser, D.B.Walker, A.M.Serious cardiovascular events and mortality among patients with schizophrenia J Nerv Ment Dis 192 2004 19–27CrossRefGoogle ScholarPubMed
McClave, A.K.McKnight-Eily, L.R.Davis, S.P.Dube, S.R.Smoking characteristics of adults with selected lifetime mental illnesses: results from the 2007 national health interview survey Am J Public Health 100 2010 2464–2472CrossRefGoogle ScholarPubMed
de Leon, J.Diaz, F.J.A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors Schizophr Res 76 2005 135–157CrossRefGoogle ScholarPubMed
World Health Organisation The tobacco atlas 2002 WHO GenevaGoogle Scholar
Demyttenaere, K.Bruffaerts, R.Posada-Villa, J.Gasquet, I.Kovess, V.Lepine, J.P.Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys Jama 291 2004 2581–2590Google ScholarPubMed
European Commission. Eurostat: your key to European statistics. 2010Google Scholar
United Nations Economic Commission for Europe. UNECE Statistical Database. 2010 http://epp.eurostat.ec.europa.eu/portal/page/portal/eurostat/home/Google Scholar
Weinbrenner, S.Assion, H.J.Stargardt, T.Busse, R.Juckel, G.Gericke, C.A.Drug prescription patterns in schizophrenia outpatients: analysis of data from a German health insurance fund Pharmacopsychiatry 42 2009 66–71CrossRefGoogle ScholarPubMed
Caceres, M.C.Penas-Lledo, E.M.de la Rubia, A.Llerena, A.Increased use of second generation antipsychotic drugs in primary care: potential relevance for hospitalizations in schizophrenia patients Eur J Clin Pharmacol 64 2008 73–76CrossRefGoogle ScholarPubMed
Gruppo di lavoro OsMed. L’uso dei farmaci in Italia. Rapporto nazionale anno 2008. Roma: Il Pensiero Scientifico Editore (ed);2009.Google Scholar
IMS Health. 2010.Google Scholar
Mehnert, A.Sindern, J.Schröder-Bernhardi, D.Einsatz von Präparaten in psychiatrischen Indikationen. Europäischer Vergleich und Detailanalyse am Beispiel Schizophrenie Psychopharmakotherapie 17 2010 285–292Google Scholar
Broekema, W.J.de Groot, I.W.van Harten, P.N.Simultaneous prescribing of atypical antipsychotics, conventional antipsychotics and anticholinergics-a European study Pharm World Sci 29 2007 126–130CrossRefGoogle ScholarPubMed
Barbui, C.Nose, M.Mazzi, M.A.Thornicroft, G.Schene, A.Becker, T.Persistence with polypharmacy and excessive dosing in patients with schizophrenia treated in four European countries Int Clin Psychopharmacol 21 2006 355–362CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence. Schizophrenia. Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. 2009.Google Scholar
American Psychiatric Association Practice guideline for the treatment of patients with schizophrenia Second edition 2004 American Psychiatric Association Washington DCGoogle Scholar
Falkai, P.Wobrock, T.Lieberman, J.Glenthoj, B.Gattaz, W.F.Moller, H.J.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia World J Biol Psychiatry 6 2005 132–191CrossRefGoogle ScholarPubMed
Falkai, P.Wobrock, T.Lieberman, J.Glenthoj, B.Gattaz, W.F.Moller, H.J.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, part 2: long-term treatment of schizophrenia World J Biol Psychiatry 7 2006 5–40CrossRefGoogle ScholarPubMed
Zink, M.Englisch, S.Meyer-Lindenberg, A.Polypharmacy in schizophrenia Curr Opin Psychiatry 23 2010 103–111CrossRefGoogle Scholar
Gaebel, W.Weinmann, S.Sartorius, N.Rutz, W.McIntyre, J.S.Schizophrenia practice guidelines: international survey and comparison Br J Psychiatry 187 2005 248–255CrossRefGoogle ScholarPubMed
Leucht, S.Corves, C.Arbter, D.Engel, R.R.Li, C.Davis, J.M.Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis Lancet 373 2009 31–41CrossRefGoogle ScholarPubMed
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