关键词: Antipsychotics Case management Clinical severity Follow-up Mirror-image study Schizophrenia Suicide Treatment adherence

Mesh : Adult Antipsychotic Agents / therapeutic use Case Management Community Mental Health Services Delayed-Action Preparations / therapeutic use Female Follow-Up Studies Hospitalization / statistics & numerical data Humans Longitudinal Studies Male Middle Aged Patient Compliance / psychology statistics & numerical data Recurrence Retrospective Studies Risk Factors Schizophrenia / drug therapy epidemiology Schizophrenic Psychology Severity of Illness Index Suicide, Attempted / psychology statistics & numerical data

来  源:   DOI:10.1016/j.psychres.2019.112479   PDF(Sci-hub)

Abstract:
Lack of treatment compliance in patients with schizophrenia is a risk factor that leads to illness-relapse, hospitalization and potentially strengthens suicidal behavior. The purpose of this investigation was to assess treatment adherence, reasons for treatment discharge, suicidal behaviour and impact of route of antipsychotics administration in a group of patients with schizophrenia treated in a comprehensive, community-based, intensive case managed program for people with severe mental illness. And to compare it to previous standard treatment received in mental health units (MHU). An observational, longitudinal, mirror-image study of patients with severe schizophrenia (N = 344) was carried out: ten years of follow-up (Program) and ten years retrospective (MHU). Reasons for treatment discharge, suicide attempts and antipsychotic (AP) medication were recorded. Treatment adherence during the Program was higher than in MHU (abandonment of treatment: 12.2% vs. 84.3% of patients). Forty patients died during follow-up, five of them due to suicide. Suicidal attempts significantly decreased during Program treatment compared to the standard one (7.6% vs. 38.9% of patients). Long-acting injectable (LAI) AP medication was significantly related to this outcome. A combination of intensive case-managed and LAIAP treatment helped to improve compliance and to reduce suicidal behavior compared to standard treatment in patients with severe schizophrenia.
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