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Relapse prevention in schizophrenia: attitudes of neurologists-psychiatrists

Published online by Cambridge University Press:  16 April 2020

J.D. Bergiannaki ,
J. Hatzimanolis ,
J. Liappas ,
P.N. Sakkas  and
C.N. Stefanis
J. Hatzimanolis
Affiliation:
University Mental Health Research Institute, Eginition Hospital, Vas. Sophias Ave. 72-74, GR115 28 Athens, Greece
J. Liappas
Affiliation:
University Mental Health Research Institute, Eginition Hospital, Vas. Sophias Ave. 72-74, GR115 28 Athens, Greece
P.N. Sakkas
Affiliation:
University Mental Health Research Institute, Eginition Hospital, Vas. Sophias Ave. 72-74, GR115 28 Athens, Greece
C.N. Stefanis
Affiliation:
University Mental Health Research Institute, Eginition Hospital, Vas. Sophias Ave. 72-74, GR115 28 Athens, Greece
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Abstract

The overall high relapse rates observed in schizophrenia are attributed to several causes. One important factor influencing satisfactory prevention of relapse is the lack of consistent treatment strategies among medical doctors, especially neurologists-psychiatrists. Nearly one-third of the members of the Hellenic Society of Neurology and Psychiatry were asked to fill in anonymously a structured questionnaire on their treatment attitudes and prescribing tactics regarding schizophrenic patients both after the first schizophrenic episode and after multiple episodes. The majority of Greek neurologists-psychiatrists seem to adopt prescribing habits that approximate the current international standards for prevention of schizophrenic relapse. Their attitudes regarding the treatment and prevention of relapse for the first schizophrenic episode and first relapse are determined from multiple factors. These are: the expected relapse rates after the first episode, the expected prevalence of extrapyramidal side effects following a long-term neuroleptic treatment, the patient’s expected treatment compliance after the first episode, the doctor’s experience with treating schizophrenics, and lastly the knowledge of current literature on the topic. These results point to the need for continuing education, especially of the younger mental health professionals and those working in the private sector, addressing the issue of the actual risk of developing side effects from the treatment. In due course, benefits could result for everyday psychiatric practice and the patients’ compliance with treatment.

Keywords

neurologists-psychiatristspreventionrelapseschizophreniatreatment attitudes
Type
Original article
Information
European Psychiatry , Volume 16 , Issue 2 , March 2001 , pp. 90 - 98
Copyright
Copyright © Éditions scientifiques et médicales Elsevier SAS

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References

Angermeyer, M.C., Siara, C.S.Effects on assassination attempts on Lafontaine and Schauble on public opinion about psychiatric patients. Part 2: 1991 development. Nervenarzt 1994; 65 Suppl 382: 49–56.Google ScholarPubMed
Baldessarini, R.J., Cohen, B.M., Teicher, M.H.Significance of neuroleptic dose and plasma levels in the pharmacological treatment of psychoses. Arch Gen Psychiatry 1988; 45: 79–91.CrossRefGoogle Scholar
Baüml, J., Kissling, W., Meurer, C., Wais, A., Lauter, H.Informationszentrierte Angehörigengruppen zur Complianceverbesserung bei schizophrenen Patienten. Psychiat Prax 1991; 18: 48–54.Google Scholar
Bleuler, M.The schizophrenic disorders–long-term patient and family studies New Haven: Yale University Press; 1978.Google Scholar
Citrome, L.New antipsychotic medications: what advantages do they offer? Postgrad M 1997; 101: 207–210.CrossRefGoogle ScholarPubMed
Crow, T.J., McMillan, J.F., Johnson, A.L., Johnstone, E.C.The Northwick Park study of first episodes of schizophrenia: II. A randomized controlled trial of prophylactic neuroleptic treatment Br J Psychiatry 1986; 148: 120–127.CrossRefGoogle Scholar
Davis, J.M.Overview: maintenance of therapy in psychiatry. Am J Psychiatry 1975; 132: 1237–1245.Google Scholar
Davis, J.M.Antipsychotic drugsKaplan, H.I, Freedman, A.M, Sadock, B.JComprehensive textbook of psychiatry 3rdBaltimore: Williams and Wilkins; 1980. p. 2257–2289.Google Scholar
Davis, J.Maintenance medicationBarnes, T.R.EDepot neuroleptics: a consensus London: Mediscript; 1988. p. 47–52.Google Scholar
Denker, S.J., May, P.R.A.The treatment of acute psychosis Copenhagen: Lundbeck; 1986.Google Scholar
Fenton, W.S., Blyler, C.R., Heinssen, R.K.Determinants of medication compliance in schizophrenia: empirical and clinical findings Schizophr Bull 1997; 23: 637–651.Google Scholar
Fleischhacker, W.W., Meise, U.The current status of maintenance treatment in schizophreniaKissling, WGuidelines for neuroleptic relapse prevention in schizophrenia New York: Springer-Verlag; 1991. p. 13–15.CrossRefGoogle Scholar
Gäbel, W.Towards the improvement of compliance: the significance of psycho-education and new antipsychotic drugs Int Clin Psychopharmacol 1997; 12 Suppl 1: S37–S42.CrossRefGoogle Scholar
Gäbel, W., Pietzcker, A.Indikation zur neuroleptischen Langzeitmedikation – standardverfahren oder individualprognostisch geleitete Intervention? Nervenarzt 1983; 54: 467–476.Google Scholar
Gäbel, W., Pietzcker, A.One-year outcome of schizophrenic patients – the interaction of chronicity and neuroleptic treatment Pharmacopsychiatry 1985; 18: 235–239.Google Scholar
Gäbel, W., Marder, S.Conclusions and treatment recommendations for the acute episode in schizophrenia Int Clin Psychopharmacol 1996; 11 Suppl 2: 93–100.Google Scholar
Gerlach, J., Casey, D.E.Tardive dyskinesia Acta Psychiatr Scand 1988; 77: 369–378.CrossRefGoogle Scholar
Gjerris, A., Kissling, W.Concluding remarks Acta Psychiatr Scand 1994; 89 Suppl 382: 93–93.CrossRefGoogle Scholar
Gmür, M., Tschopp, A.Die Behandlungskontinuität bei schizophrenen Patienten in der Ambulanz. Eine Fünfjahresnachuntersuchung Nervenarzt 1988; 59: 727–730.Google Scholar
Guenther, V., Meise, U.Compliance – Ein Komplexes Problem Wien Med Wochenschr 1990; 140: 265–269.Google Scholar
Gunderson, J.G., Mosher, L.R.The cost of schizophrenia Am J Psychiatry 1975; 132: 901–906.Google Scholar
Hall, W., Goldstein, G., Andrews, G., Lapsley, H., Bartels, R., Silove, D.Estimating the economic costs of schizophrenia Schizophr Bull 1985; 11: 598–610.Google Scholar
Hogarty, G.E., Goldberg, S.C.Collaborative Study Group Drug and sociotherapy in the aftercare of schizophrenic patients: one year relapse rates Arch Gen Psychiatry 1974; 28: 54–64.Google Scholar
Hogarty, G.E.Resistance of schizophrenic patients to social and vocational rehabilitationDencker, S.J, Kulhanek, FTreatment resistance in schizophrenia Wiesbaden: Braunschweig; 1988.Google Scholar
Hornung, W.P., Kieserg, A., Feldmann, R., Buchkremer, G.Psychoeducational training for schizophrenic patients: background, procedure and empirical findings Patient Educ Couns 1996; 29: 257–268.Google Scholar
Janicak, P.G., Davis, J.M.Antipsychotic dosing strategies in acute schizophrenia Int Clin Psychopharmacol 1996; 11 Suppl 2: 35–40.10.1097/00004850-199605002-00006CrossRefGoogle Scholar
Johnstone, E.C., Crow, T.J., Johnson, A.L., Macmillan, J.F.The Northwick Park study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission Br J Psychiatry 1986; 148: 115–120.Google Scholar
Johnstone, E.C., Geddes, J.How high is the relapse rate in schizophrenia? Acta Psychiatr Scand 1994; 89 Suppl 382: 6–10.Google Scholar
Kane, J.M.Problems of compliance in the outpatient treatment of schizophrenia J Clin Psychiatry 1983; 1: 3–6.Google Scholar
Kane, J.M.Compliance issues in outpatient treatment J Clin Psychopharmacol 1985; 5: 225–275.Google Scholar
Kane, J.M.Treatment of schizophrenia Schizophr Bull 1987; 13: 133–156.CrossRefGoogle Scholar
Kane, J.M.Dosage and route of administration of neuroleptic drugs during different phases of a schizophrenic illnessKissling, WGuidelines for neuroleptic relapse prevention in schizophrenia New York: Springer-Verlag; 1991. p. 85–93.CrossRefGoogle Scholar
Kane, J.M., Rifkin, A., Quitkin, F., Naya, D., Ramos-Lorenzi, J.Fluphenazine versus placebo in patients with remitted acute first episode schizophrenia Arch Gen Psychiatry 1982; 39: 70–73.Google Scholar
Kane, J.M., Woerner, M., Borenstein, M., Wegner, J., Lieberman, J.Integrating incidence and prevalence of tardive dyskinesia Psychopharmacol Bull 1986; 22: 254–258.Google Scholar
Kissling, W.Depot neuroleptics – a step forward? Consensus regarding indication for prophylactic neuroleptic treatment – necessary, but unattainable?Barnes, T.R.EDepot neuroleptics: a consensus London: Mediscript; 1988. p. 41–46.Google Scholar
Kissling, WGuidelines for neuroleptic relapse prevention in schizophrenia Berlin: Springer-Verlag; 1991.CrossRefGoogle Scholar
Kissling, W.Compliance, quality assurance and standards for relapse prevention in schizophrenia Acta Psychiatr Scand 1994; 89 Suppl 382: 16–24.Google Scholar
Kissling, W., Kane, J.M., Barnes, T.R.E., Dencker, S.J., Fleischhacker, W.W., Goldstein, M.J.et al.Guidelines for neuroleptic relapse prevention in schizophrenia: towards a consensus viewKissling, WGuidelines for neuroleptic relapse prevention in schizophrenia New York: Springer-Verlag; 1991. p. 155–163.CrossRefGoogle Scholar
Lehman, A.F., Steinwachs, D.M.Survey Co-Investigators of the PORT Project. Patterns of usual care for schizophrenia: initial results from the schizophrenia patient outcomes research team (PORT) client survey Schizophr Bull 1998; 24: 11–20.Google Scholar
Lewandowski, L., Buchkremer, G.Therapeutische Gruppenarbeit mit Angehörigen schizophrener Patienten Z Klin Psychol 1988; 17: 210–224.Google Scholar
Mantonakis, J., Markidis, M., Kontaxakis, V., Liakos, A.A scale for detection of negative attitude towards medication among relatives of schizophrenic patients Acta Psychiatr Scand 1985; 2: 186–189.Google Scholar
Marsden, C.D.Is tardive dyskinesia a unique disorder? Casey, D.E, Chase, T.N, Christensen, A.V, Gerlach, JDyskinesia – research and treatment. (Psychopharmacology series, vol. 2.)Berlin: Springer; 1985.10.1007/978-3-642-70140-5_8CrossRefGoogle ScholarPubMed
Marder, S.R.The role of dosage and plasma levels in neuroleptic relapse prevention Acta Psychiatr Scand 1994; 89 Suppl 382: 25–27.Google Scholar
Marder, S.R.Pharmacological treatment strategies in acute schizophrenia Int Clin Psychopharmacol 1996; 11 Suppl 2: 29–34.CrossRefGoogle Scholar
Maurer, K., Biehl, H.Klinikaufenthalte und produktive Rückfalle bei ersterkrankten Schizophrenen Nervenheilkunde 1988; 7: 279–290.Google Scholar
McEnvoy, J.P., Hogerty, G.E., Steingard, S.Optimal dose of neuroleptics in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose Arch Gen Psychiatry 1991; 48: 739–745.Google Scholar
McGlashan, T.H.A selective review of recent North America long-term follow-up studies of schizophrenia Schizophr Bull 1988; 14: 515–542.Google Scholar
Meise, U., Fleischhacker, W.W.Perspectives on treatment needs in schizophrenia Br J Psychiatry 1996; 168 Suppl 29: 9–16.Google Scholar
Müller, PZur Rezidivprophylaxe Schizophrener Psychosen Stuttgart: Enke; 1982.Google Scholar
Pietzcker, A.Neuroleptische Langzeit-Medikation in der ambulanten Behandlung schizophren Kranker Hamburg: Promonta Schriften; 1987.Google Scholar
Rabiner, C.J., Wegner, J.T., Kane, J.M.Outcome study of first episode psychosis: I. Relapse rates after one year Am J Psychiatry 1986; 143: 1155–1158.Google Scholar
Rice, D.P., Kelman, S., Miller, L.S.The economic burden of mental illness Hosp Community Psychiatry 1992; 43: 1227–1232.Google Scholar
Rifkin, A.A historical review of the adverse reactions to neuroleptic agents J Clin Psychiatry 1987; 3 Suppl 48: 6–6Google Scholar
Sheitman, B.B., Lee, H., Strauss, R., Lieberman, J.A.The evaluation and treatment of first-episode psychosis Schizophr Bull 1997; 23: 653–661.Google Scholar
Shepherd, M., Watt, D., Falloon, I., Smeeton, N.The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenia Psychol Med Monogr Suppl 15 Cambridge: Cambridge University Press; 1989.Google Scholar
Tegeler, J.Maintenance neuroleptic treatment in schizophreniaKissling, WGuidelines for neuroleptic relapse prevention in schizophrenia New York: Springer-Verlag; 1991. p. 34–37.CrossRefGoogle Scholar
Van Putten, T.Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 1974; 31: 67–72.Google Scholar
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