New Trends in the Therapy of Schizophrenia

Overview

Before the psychopharmacological era, the main aims of treatment were the improvement of selfcare, reduction of aggression and self-injury. After the arrival of antipsychotics (AP) the aims of treatment have been becoming more ambitious. Nowadays, remission, improvement of functioning and quality of life are the goals. Remission is defined in terms of symptoms, similarly to affective disorders. Remission is significantly connected with compliance (adherence to the treatment). Studies dealing with these problems suggest that about two thirds of patients do not take AP as prescribed, or even do not take them at all. The ADHES study was aimed at psychiatrists’ understanding of factors leading to insufficient adherence. Questionnaire-based naturalistic survey that incorporated 80 psychiatrists and 820 of their patients has found that Czech psychiatrists’ opinions do not differ from those of psychiatrists from other countries. The incidence of partial compliance and noncompliance has been evaluated in accordance with the available literature. Psychiatrists judged that the impairment of cognitive functioning, life conditions and stigma were important factors in about half of their patients, in smaller proportion of patients it was co-morbid substance abuse. With the availability of atypical AP (with better tolerability), long-acting atypicals (positive influence of compliance) and continuous psychoeducation, remission becomes an attainable clinical goal.

Key words:
schizophrenia, remission, compliance.