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Journal Article 2007; 28(Suppl 1): 27-33 PubMed PMID: 17262009 Citation  Keywords:  Antipsychotic Agents:therapeutic use, Humans, Patient Compliance, Psychiatry, Psychotic Disorders:drug therapy, Treatment Outcome,.   

: Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid....

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Journal Article 2007; 28(Suppl 1): 35-45 PubMed PMID: 17262008 Citation  Keywords:  Humans, Long-Term Care, Prejudice, Psychotic Disorders:drug therapy, Self Concept, Stereotyping,.   

: Stigma is linked to negative prejudices without examining whether there is any justification for such behaviour. Over time, various efforts have been made to reduce prejudice toward people with mental illness. Yet, the World Health Organization (WHO) World Health Report still describes stigma as one of the greatest obstacles to the treatment of mental illness. While schizophrenia, among other mental illnesses, is the most stigmatized even to the point that some want the name of the illness to be hidden or changed, patients with bipolar illness may also be exposed to stigma. The degree of stigmatization has been found to be positively associated with the severity of the mental disorder, and stigma is carried out not only by patients but also by their families in correlation with the severity. Tragically, people with mental illness themselves are as negative in their opinions about mental illness as is the general public, and concerns about stigma adversely affect self-esteem and adaptive social functioning. There are many programmes worldwide for the fight against stigmatization, and there is clear recognition of the fact that stigma can only be successfully eliminated if the programme becomes a normal part of health service rather than of campaigns of limited duration....

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Journal Article 2007; 28(Suppl 1): 49-70 PubMed PMID: 17262007 Citation  Keywords:  Antipsychotic Agents:therapeutic use, Double-Blind Method, Humans, Placebos, Randomized Controlled Trials as Topic, Recurrence, Research Design, Schizophrenia:drug therapy, Treatment Outcome,.   

: Fourteen long-term (duration at least 26 months) double-blind, randomized studies comparing second-generation antipsychotics (SGAs) with placebo, conventional antipsychotics, or two or more SGAs, published after 2002 have been reviewed and are summarized in this chapter. Methodological problems and factors influencing results such as patient populations involved, outcome criteria, and dosages of evaluated drugs are discussed....

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Journal Article 2007; 28(Suppl 1): 71-93 PubMed PMID: 17262006 Citation  Keywords:  Anticonvulsants:therapeutic use, Antidepressive Agents:therapeutic use, Antimanic Agents:therapeutic use, Antipsychotic Agents:therapeutic use, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Drug Therapy, Combination, Humans, Lithium Carbonate:t.   

: Several lines of clinical, genetic, and pharmacological evidence point to an association between bipolar and psychotic disorders. The goals of maintenance and prophylactic treatment of bipolar disorder include the prevention of new episodes and the improvement of social, family, and occupational functioning. This goal can be mainly achieved by using long-term adequate pharmacological treatment that is tolerable to patients. Among mood-stabilizers, the main drugs used for such treatment, the role of atypical antipsychotics has greatly increased in recent years. Lithium still remains the drug that has produced the most convincing evidence of prophylactic action and has undergone the longest periods of observation. There has also been good confirmation for the maintenance efficacy of such anticonvulsant drugs as carbamazepine, valproate, and lamotrigine, the last having the strongest properties for prophylaxis of depressive episodes. The case for the usefulness of second-generation antipsychotic drugs in the long-term treatment of bipolar disorder has been rapidly accumulating. Based on controlled trials, the best evidence for maintenance efficacy exists for olanzapine. The vast majority of patients with bipolar illness experience inadequate response to monotherapy with mood-stabilizing drugs during long-term treatment. Some issues connected with polypharmacy targeting optimal maintenance results are discussed. In addition, the long-term management and the role of antidepressants in treatment of non-bipolar I illness is also briefly described....

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Journal Article 2007; 28(Suppl 1): 95-116 PubMed PMID: 17262005 Citation  Keywords:  Antipsychotic Agents:metabolism, Humans, Patient Compliance, Risk Factors, Schizophrenia:drug therapy, Schizophrenic Psychology, Treatment Refusal,.   

: Adherence to treatment is a general indicator of quality and success of communication between the physician and the patient. It means the extent to which patient behaviour, in terms of taking medications, following diets, or executing life-style changes, coincides with medical or health advice. Nonadherence to antipsychotic therapy in patients with schizophrenia is far more widespread than clinicians assume. Lower nonadherence in therapy based on antipsychotics of the second generation compared with conventional medications has already been indicated by early reports. The consequences of nonadherence include exacerbation of symptoms, an increased relapse rate, psychiatric hospitalization hospitalisation, and less favourable patient prognosis. There are several factors that cause treatment nonadherence in schizophrenia: causes derived from the schizophrenic disorder itself, patient characteristics, causes associated associated with the health-care system, and the antipsychotic treatment itself....

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Journal Article 2007; 28(Suppl 1): 117-133 PubMed PMID: 17262004 Citation  Keywords:  Antipsychotic Agents:adverse effects, Bipolar Disorder:drug therapy, Clinical Trials as Topic, Humans, Long-Term Care, Quality of Life, Schizophrenia:drug therapy, Treatment Outcome,.   

: Health-related quality of life (QoL) represents important measure of treatment outcome in mental disorders. Numerous studies indicate that QoL of people with schizophrenia and bipolar disorder is similar to that of patients with chronic physical conditions. It has been shown that schizophrenia patients can themselves reliably assess their QoL; in addition to the objective scales various self-reporting instruments are used. Patients with bipolar disorder have QoL consistently higher than patients with schizophrenia and similar to that found in people with unipolar depression. Quality of life can be negatively affected by drug-induced side-effects and subjective treatment response. The second-generation antipsychotics (SGA) have superior efficacy on QoL over classical antipsychotics in approximately half of the studies with schizophrenia; in the other half those groups are comparable. However, in none of the trials novel antipsychotics were inferior. All SGA (clozapine, olanzapine, risperidone, amisulpride, quetiapine, ziprasidone, or remoxipride) have been found to be beneficial for patients well-being. The most investigated drugs that convincingly improve QoL in schizophrenia are olanzapine and risperidone (including depot form). Results of several studies indicate that individual antipsychotics may differ in their effects on QoL, with suggested superiority of olanzapine. In bipolar disorder, SGA consistently showed their superiority over placebo in effects on QoL. The most studied SGA in bipolar disorder is olanzapine. More long-term controlled double-blind trials are needed to definitively uphold superiority and different effects of individual SGA on QoL of patients with schizophrenia and bipolar disorder....

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Journal Article 2007; 28(Suppl 1): 135-145 PubMed PMID: 17262003 Citation  Keywords:  Family Therapy, Humans, Patient Compliance, Psychotherapy, Psychotherapy, Group, Schizophrenia:therapy, Schizophrenic Psychology,.   

: The author gives a critical overview of various psychotherapeutic approaches used with persons with schizophrenia and their families. It is emphasized that these approaches are to be used in conjunction with pharmacological treatment and should always be individualized for each patient depending on the phase and severity of illness. Individual psychotherapy, particularly cognitive-behavioural modality, group therapy, and family therapy are described in some detail. Special attention is given to compliance therapy....

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Journal Article 2007; 28(Suppl 1): 147-159 PubMed PMID: 17262002 Citation  Keywords:  Caregivers, Family, Family Relations, Humans, Patient Compliance, Quality of Life, Schizophrenia:therapy, Schizophrenic Psychology, Socioenvironmental Therapy,.   

: Family represents an important supportive social network for most patients with schizophrenia. In order to provide safe and low-stress environment, necessary for the successful long-term treatment of schizophrenia the family must be helped. Family members suffer both emotionally and financially. Their burden is high and quality of life is low. Relatives change their life values and preferences when a severe mental illness occurs in the family and are ready to cooperate. Family interventions constitute an integral part of complex schizophrenia treatment. To be successful interventions must take into account relatives beliefs, perspectives and issues of concern. The goal of this paper is to 1) overview studies on family burden, 2) provide theoretical background for family interventions, 3) describe a family psychoeducational approach as an optimal treatment modification....

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