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Perspectives on Treatment Needs in Schizophrenia

Published online by Cambridge University Press:  06 August 2018

Ullrich Meise  and
W. Wolfgang Fleischhacker
Ullrich Meise
Affiliation:
Department of General Psychiatry, Innsbruck University Hospital
W. Wolfgang Fleischhacker*
Affiliation:
Department of Biological Psychiatry, Innsbruck University Hospital, Innsbruck, Austria
*
Professor W. Wolfgang Fleischhacker, Department of Biological Psychiatry, Innsbruck University Hospital, A-6020, Innsbruck, Austria
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Extract

Schizophrenia is one of the most severe and debilitating major psychiatric diseases, with a yearly prevalence of 0.4–0.8% in the general population (Dohrenwend, 1980; Flekkoy, 1987) and a lifetime risk of 1–1.5% (Regier et al, 1984; Robins et al, 1984). It is the prototype of a severe mental illness, with the capacity to disrupt routine daily functions in all areas of life, but especially work, social relationships, and self-care. Schizophrenia also increases the vulnerability of a patient to physical and other mental disturbances (Koran et al, 1989). Until recently, the clinical course of this disease has been far worse than that of most other psychiatric disorders, thus making it devastating for many individuals and costly to society (McGlashan, 1988). Schizophrenic patients occupy 20–25% of all the beds available for psychiatric in-patient care and account for 40% of all long-stay hospital days (Talbott et al, 1987; Meise et al, 1992). It is not so much the direct costs associated with treatment, but rather the indirect costs, such as those that arise from morbidity and mortality, that place a severe burden on the social economy (Gunderson & Mosher, 1975; Hall et al, 1985; Rice et al, 1992).

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue S29: Current Issues in the Development of Atypical Antipsychotic Drugs , May 1996 , pp. 9 - 16
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Andrews, G. (1991) The cost of schizophrenia revisited. Schizophrenia Bulletin, 17, 389–394.Google Scholar
Anthony, W. A. (1979) Principles of Psychiatric Rehabilitation. Baltimore: University Park Press.Google Scholar
Asarnow, R. F., Granholm, E. & Sherman, T. (1991) Span of apprehension in schizophrenia. In Handbook of Schizophrenia, Vol. 5: Neuropsychology, Psychophysiology and Information Processing (eds Steinhause, S. R., Gruzelier, J. H. & Zubin, J.). Amsterdam: Elsevier.Google Scholar
Attkisson, C., Cook, J., Karno, M., et al (1992) Clinical services research. Schizophrenia Bulletin, 18, 561–626.Google Scholar
Bachrach, L. L. (1981) Continuity of care for chronic mental patients: a conceptual analysis. American Journal of Psychiatry, 138, 1449–1456.Google ScholarPubMed
Bachrach, L. L. (1983) Deinstitutionalization: an overview of the issues. Bulletin of the Menninger Clinic, 47, 63–188.Google Scholar
Bachrach, L. L. (1992) Psychosocial rehabilitation and psychiatry in the care of long-term patients. American Journal of Psychiatry, 149, 1455–1463.Google ScholarPubMed
Barnas, C., Stuppack, C., Miller, C., et al (1992) Zotepine in the treatment of schizophrenic patients with prevailingly negative symptoms: a double-blind trial vs. haloperidol. International Clinical Psychopharmacology, 7, 23–27.Google Scholar
Bellack, A. S. & Mueser, K. T. (1993) Psychosocial treatment for schizophrenia. Schizophrenia Bulletin, 19, 317–336.CrossRefGoogle ScholarPubMed
Blackwell, B. (1973) Drug therapy. patient compliance. New England Journal of Medicine, 289, 249–252.Google Scholar
Bleuler, E. (1908) Die Prognose der Dementia Praecox – Schizophreniegruppe. Allgemeine Zeitschrift für Psychiatrie, 65, 436–464.Google Scholar
Brenner, H. D., Hodel, B., Roder, V., et al (1992) Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia. Schizophrenia Bulletin, 18, 21–26.Google Scholar
Carpenter, W. T., Heinrich, D. W. & Alphs, L. D. (1985) Treatment of negative symptoms. Schizophrenia Bulletin, 11, 440–452.Google Scholar
Carpenter, W. T., Hanlon, T. E., Heinrichs, D. W., et al (1990) Continuous versus targeted medication in schizophrenic outpatients: outcome results. American Journal of Psychiatry, 147, 1138–1148.Google ScholarPubMed
Chen, M. K. (1978) A quantitative index of access to primary medical care for health planning. Socioeconomic Science, 12, 295–301.Google Scholar
Cheung, H. K. (1981) Schizophrenics fully remitted in neuroleptics for 3–5 years: to stop or continue drugs? British Journal of Psychiatry, 138, 490–494.CrossRefGoogle ScholarPubMed
Clozapine Study Group (1993) The safety and efficacy of clozapine in severe treatment-resistant schizophrenic patients in the UK. British Journal of Psychiatry, 163, 150–154.Google Scholar
Davis, J. M. (1985) Antipsychotic drugs. In Comprehensive Textbook of Psychiatry IV, Vol. 2 (4th edn) (eds Kaplan, H. I. & Sadock, B. J.), pp. 1481–1513. Baltimore: Williams & Wilkins.Google Scholar
Davis, J. M. & Casper, R. (1977) Antipsychotic drugs: clinical pharmacology and therapeutic use. Drugs, 14, 260–282.CrossRefGoogle ScholarPubMed
Davis, J. M. & Andriukaitis, S. (1986) The natural course of schizophrenia and effective maintenance drug treatment. Journal of Clinical Psychopharmacology, 6 (suppl. 1), 2S–10S.Google Scholar
Deutscher Bundestag (1975) Bericht über die Lage der Psychiatrie in der Bundesrepublik Deutschland, Drucksache 7/4200, pp. 79–82. Bonn: Hans Heger.Google Scholar
Dohrenwend, B. P. (1980) Mental Illness in the United States. New York: Praeger.Google Scholar
Drake, R. E., Wallach, M. A. & Hoffman, J. S. (1989) Housing instability and homelessness among aftercare patients of an urban state hospital. Hospital and Community Psychiatry, 40, 46–51.Google ScholarPubMed
Dworin, J., Green, J. A. & Young, H. H. (1964) A follow-up study of relationships between distance from the clinic, degree of disability and requests for psychiatric treatment. Journal of Clinical Psychology, 20, 393–395.Google Scholar
Falloon, I. R. D., Boyd, J. L., McGill, C. W., et al (1982) Family management in the prevention of exacerbations of schizophrenia: a controlled study. New England Journal of Medicine, 24, 1437–1440.Google Scholar
Fenton, W. S. & McGlashan, T. H. (1987) Sustained remission in drug-free schizophrenic patients. American Journal of Psychiatry, 144, 1306–1309.Google Scholar
Fleischhacker, W. W. (1995) New drugs for the treatment of schizophrenic patients. Acta Psychiatrica Scandinavica, 91 (suppl. 388), 24–30.Google Scholar
Fleischhacker, W. W. & Whitworth, A. B. (1994) Adverse effects of antipsychotic drugs. Current Opinion in Psychiatry, 7, 71–75.CrossRefGoogle Scholar
Fleischhacker, W. W., Meise, U., Guenther, V., et al (1994) Compliance with antipsychotic drug treatment: influence of side effects. Acta Psychiatrica Scandinavica, 89 (suppl. 382), 11–15.Google Scholar
Flekkoy, K. (1987) Epidemiologic und Genetik. In Psychiatrie der Gegenwart 4: Schizophrenien (eds Kisker, K. P., Lauter, H., Meyer, J. E., et al), pp. 119–153. New York: Springer.Google Scholar
Gaebel, W. & Pietzcker, A. (1987) Prospective study of course of illness in schizophrenia: Part III. Treatment and outcome. Schizophrenia Bulletin, 13, 307–316.CrossRefGoogle ScholarPubMed
Glazer, W. M. & Kane, J. M. (1992) Depot neuroleptic therapy: an underutilized treatment option. Journal of Clinical Psychiatry, 53, 426–433.Google ScholarPubMed
Gmür, M. (1986) Schizophrenieverlauf und Entinstitutionalisierung. Stuttgart: Enke.Google Scholar
Gmür, M. & Tschopp, A. (1988) Die Behandlungskontinuität bei Schizophrenen Patienten in der Ambulanz. Nervenarzt, 59, 727–730.Google Scholar
Goering, P., Wasylenki, D., Farkas, M., et al (1988) What difference does case management make? Hospital and Community Psychiatry, 39, 272–276.Google Scholar
Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Doubleday-Anchor.Google Scholar
Goldstrom, I. D. & Manderscheid, R. W. (1982) The chronically mentally ill: a descriptive analysis from the Uniform Client Data Instrument. Community Support Service Journal, 2, 4–9.Google Scholar
Guenther, V. & Meise, U. (1990) Compliance – Ein komplexes Problem. Wiener Medizinische Wochenschrift, 140, 365–369.Google Scholar
Gunderson, J. G. & Mosher, L. R. (1975) The cost of schizophrenia. American Journal of Psychiatry, 132, 901–906.Google Scholar
Hall, W., Goldstein, G., Andrews, G., et al (1985) Estimating the economic costs of schizophrenia. Schizophrenia Bulletin, 11, 598–610.Google Scholar
Harding, C. M., Brooks, G. W., Ashikaga, T., et al (1987) The Vermont longitudinal study of persons with severe mental illness. II. Long-term outcome of subjects who met retrospectively DSM–III criteria for schizophrenia. American Journal of Psychiatry, 144, 718–735.Google Scholar
Harding, C. M., Zubin, J. & Strauss, J. (1988) Chronicity in schizophrenia: fact, practical fact, or artifact? Hospital and Community Psychiatry, 38, 477–486.Google Scholar
Hatfield, A. B. (1989) Serving the unserved in community rehabilitation programs. Psychosocial Rehabilitation Journal, 13, 71–82.CrossRefGoogle Scholar
Herz, M. I., Glazer, W. M., Mostert, M. A., et al (1991) Intermittent vs maintenance medication in schizophrenia: two-year results. Archives of General Psychiatry, 48, 333–339.Google Scholar
Hirsch, S. R. (1988) Psychiatric Beds and Resources: Factors Influencing Bed Use and Service Planning. London: Gaskell.Google Scholar
Hogarty, G. E., Anderson, C. M., Resii, D. J., et al (1991) Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. II. Two-year effects of a controlled trial on relapse and adjustment. Archives of General Psychiatry, 48, 340–347.Google Scholar
Hoult, J., Reynolds, I. & Charbonneau-Powis, M. (1983) Psychiatric hospital versus community treatment. Australian and New Zealand Journal of Psychiatry, 17, 160–167.Google Scholar
Jarman, B., Hirsch, S., White, P., et al (1992) Predicting psychiatric admission rates. British Medical Journal, 304, 1146–1151.CrossRefGoogle ScholarPubMed
Johnson, D. A. W., Ludlow, J. M., Street, K., et al (1983) Double-blind comparison of half-dose and standard-dose flupenthixol decanoate in the maintenance treatment of stabilised out-patients with schizophrenia. British Journal of Psychiatry, 151, 634–638.Google Scholar
Jolley, A. G., Hirsch, S. R., Morrison, E., et al (1989) Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients: clinical outcome at one year. British Medical Journal, 298, 985–990.CrossRefGoogle ScholarPubMed
Kane, J. M. (1987) Treatment of schizophrenia. Schizophrenia Bulletin, 13, 133–156.CrossRefGoogle ScholarPubMed
Kane, J. M., Honigfeld, G., Singer, J., et al (1988) Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Archives of General Psychiatry, 45, 789–796.Google Scholar
Kane, J. M. & Marder, S. R. (1993) Psychopharmacologic treatment of schizophrenia. Schizophrenia Bulletin, 19, 287–302.CrossRefGoogle ScholarPubMed
Kirch, D. G., Keith, S. J. & Matthews, S. M. (1992) Research on first-episode psychosis: report on a National Institute of Mental Health Workshop. Schizophrenia Bulletin, 18, 179–182.Google Scholar
Kissling, W. (1991) The current unsatisfactory state of relapse prevention in schizophrenic psychoses: suggestions for improvement. Clinical Neuropharmacology, 14 (suppl 2), S33–S44.Google Scholar
Koegel, P., Burnam, M. A. & Farr, R. K. (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Archives of General Psychiatry, 45, 1085–1092.CrossRefGoogle ScholarPubMed
Koegel, P., Kane, J. M., Barnes, T. R. E., et al (1991) Guidelines for neuroleptic relapse prevention in schizophrenia: towards a consensus view. In Guidelines for Relapse Prevention in Schizophrenia (ed. Kissling, W.), pp. 155–163. Berlin: Springer.Google Scholar
Koran, L. M., Sox, H. C. Jr, Marton, K. I., et al (1989) Medical evaluation of psychiatric patients. I. Results in a state mental health system. Archives of General Psychiatry, 46, 733–740.Google Scholar
Kraepelin, E. (1896) Psychiatrie (5th edn). Leipzig: Barth.Google Scholar
Kurz, M., Hummer, M., Oberbauer, H., et al (1995) Extrapyramidal side effects of clozapine and haloperidol. Psychopharmacology, 118, 52–56.Google Scholar
Lam, D. H. (1991) Psychosocial family intervention in schizophrenia: a review of empirical studies. Psychological Medicine, 21, 423–441.Google Scholar
Leff, J., Kuipers, L., Berkowitz, R., et al (1985) A controlled trial of social intervention in the families of schizophrenic patients: two-year follow-up. British Journal of Psychiatry, 146, 594–600.Google Scholar
Liberman, R. P. (1982) Assessment of social skills. Schizophrenia Bulletin, 8, 63–83.Google Scholar
Liberman, R. P., Mueser, K. T. & Wallace, C. J. (1986) Social skills training for schizophrenic individuals at risk for relapse. American Journal of Psychiatry, 143, 523–526.Google ScholarPubMed
Lieberman, J. A. (1993) Understanding the mechanism of action of atypical antipsychotic drugs: a review of compounds in use and development. British Journal of Psychiatry, 163 (suppl. 22), 7–18.Google Scholar
Lieberman, J. A., Alvir, J. M., Woerner, M., et al (1992) Prospective study of psychobiology in first-episode schizophrenia at Hillside Hospital. Schizophrenia Bulletin, 18, 351–371.Google Scholar
Malhotra, A. K., Litman, R. E. & Rickar, D. (1993) Adverse effects of antipsychotic drugs. Drug Safety, 9, 429–436.CrossRefGoogle ScholarPubMed
Marder, S. R. (1992) Risperidone: clinical development: North American results. Clinical Neuropharmacology, 15 (suppl. 1, Pt A), 92A.Google Scholar
Marder, S. R. & Meibach, R. C. (1994) Risperidone in the treatment of schizophrenia. American Journal of Psychiatry, 151, 825–835.Google Scholar
Marder, S. R., Wirsching, W. C., Van Putten, T., et al (1994) Fluphenazine vs placebo supplementation for prodromal signs of relapse in schizophrenia. Archives of General Psychiatry, 51, 280–287.Google Scholar
McGlashan, T. H. (1988) A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin, 14, 515–542.Google Scholar
Meise, U., Roessler, W., Schett, P., et al (1992) Zur Behandlungssituation psychish Kranker: Auswertungsergebnisse administrativer daten schizophrener Patienten. In Rück-fallsprophylaxe Schizophrener Patienten (ed. Koenig, P.), pp. 67–87. Vienna: Springer.Google Scholar
Meise, U., Kurz, M. & Fleischhacker, W. W. (1994) The antipsychotic maintenance treatment of schizophrenic patients: is there a consensus? Schizophrenia Bulletin, 20, 215–225.CrossRefGoogle ScholarPubMed
Meise, U., Kemmler, E., Kurz, M. & Roessler, W. (1996) Die standort qualität alsgrundlage psychiatrischer versorguags planung. Gesundheitswesen, 58, 64–73.Google Scholar
Morrison, R. L. & Bellack, A. S. (1987) Social functioning of schizophrenic patients: clinical and research issues. Schizophrenia Bulletin, 13, 715–725.Google Scholar
Mulkern, V. M. & Manderscheid, R. W. (1989) Characteristics of community support program clients in 1980 and 1984. Hospital and Community Psychiatry, 40, 165–172.Google Scholar
Nuechterlein, K. H. & Dawson, M. E. (1984) Information processing and attentional functioning in the developmental course of schizophrenic disorders. Schizophrenia Bulletin, 10, 160–203.Google Scholar
Pietzcker, A. & Gaebel, W. (1987) Prospective study of course of illness in schizophrenia: Part I. Outcome at 1 year. Schizophrenia Bulletin, 13, 287–297.Google Scholar
Pietzcker, A., Gaebel, W., Kopcke, W., et al (1993) Intermittent versus maintenance neuroleptic long-term treatment in schizophrenia: two-year results of a German multicenter study. Journal of Psychiatric Research, 27, 321–339.Google Scholar
Pollack, E. S. (1977) Mental Health Demographic Profile for Health Service Planning. National Centre for Health Statistics, Statistical Notes for Health Planners No. 4, DHEW (HRA) 77–1237. Rockville: Fishers Lane.Google Scholar
Regier, D. A., Myers, J. K., Kramer, M., et al (1984) The NIMH Epidemiologic Catchment Area Program. Archives of General Psychiatry, 41, 934–941.Google Scholar
Rice, D. P., Kelman, S. & Miller, L. S. (1992) The economic burden of mental illness. Hospital and Community Psychiatry, 43, 1227–1232.Google Scholar
Robins, L. N., Helzer, J. E., Weissman, M. M., et al (1984) Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry, 41, 949–958.Google Scholar
Roessler, W., Riecher, A., Loeffler, E., et al (1991) Community care in child psychiatry. Social Psychiatry and Psychiatric Epidemiology, 26, 28–33.Google Scholar
Roessler, W., Faetkenheuer, B. & Loeffler, W. (1993) Soziale Rehabilitation Schizophrener. Stuttgart: Enke.Google Scholar
Rosen, B. M., Goldsmith, H. F. & Redick, R. W. (1979) Demographic and social indicators: uses in mental health planning in small areas. World Health Statistics, 32, 11–101.Google Scholar
Sartorius, N., Jablensky, A., Ernberg, G., et al (1987) Course of schizophrenia in different countries: some results of a WHO comparative 5-year follow-up study. In Search for the Causes of Schizophrenia (eds Haefner, H., Gattaz, W. F. & Janzarik, W.), pp. 107–113. New York: Springer.Google Scholar
Schooler, N. R. (1985) Treatment of schizophrenia: maintenance strategies and pharmacologic tactics. In Controversies in Schizophrenia (ed. Alpert, M.). New York: Guilford Press.Google Scholar
Schooler, N. R. (1991) Maintenance medication for schizophrenia: strategies for dose reduction. Schizophrenia Bulletin, 17, 311–324.Google Scholar
Schubart, C., Schwarz, R., Krimm, B., et al (1986) Schizophrenic und Soziale Anpassung. Berlin: Springer.CrossRefGoogle Scholar
Shannon, G. W., Bashshur, R. I. & Lovett, J. E. (1986) Distance and the use of mental health services. Millbank Quarterly, 64, 302–330.Google Scholar
Shepherd, M., Watt, D., Falloon, I., et al (1989) The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine, (monograph suppl. 15), 1–46.Google Scholar
Stein, L. I. & Test, M. A. (1980) Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.Google Scholar
Stoudemire, A. & Thompson, T. (1983) Medication noncompliance: systematic approaches to evaluation and intervention. General Hospital Psychiatry, 5, 233–239.Google Scholar
Sytema, S. (1991) Social indicators and psychiatric admission rates. A case-register study in The Netherlands. Psychological Medicine, 21, 177–184.Google Scholar
Talbott, J. A., Goldman, H. H. & Ross, L. (1987) Schizophrenia: an economic perspective. Psychiatric Annals, 17, 577–579.Google Scholar
Thornicroft, G. (1991) Social deprivation and rates of treated mental disorder: developing statistical models to predict psychiatric service utilisation. British Journal of Psychiatry, 158, 475–484.Google Scholar
US Public Health Service (1961) Areawide Planning for Hospitals and Related Health Facilities, USPHS publication no. 855. Washington DC: US Government Printing Office.Google Scholar
Wallace, C. J. (1993) Psychiatric rehabilitation. Psychopharmacology Bulletin, 29, 537–548.Google Scholar
Weller, M. P. (1989) Mental illness – who cares? Nature, 339, 249–252.Google Scholar
Wing, J. K. (1987) Rehabilitation, Soziotherapie und Prävention. In Psychiatrie der Gegenwart 4: Schizophrenien (eds Kiske, H. P., Lauter, H., Meyer, J. E., et al), pp. 352–355. Berlin: Springer.Google Scholar
Winokur, G. & Tsuang, M. (1975) Suicide in mania, depression and schizophrenia. American Journal of Psychiatry, 132, 650–651.Google Scholar
Wirsching, W. C. & Marder, S. R. (1993) Drug treatment in schizophrenia. Current Opinion in Psychiatry, 6, 85–89.CrossRefGoogle Scholar
Wistedt, B., Jorgensen, A. & Wiles, D. (1982) A depot neuroleptic withdrawal study: plasma concentration of fluphenazine and flupenthixol and relapse frequency. Psychopharmacology, 78, 301–304.Google Scholar
World Health Organization (1980) International Classification of Impairments, Disabilities and Handicaps. Geneva: WHO.Google Scholar
Wyatt, R. W. (1991) Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin, 17, 325–351.Google Scholar
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