Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic

Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Antipsychotic medication prescription patterns and associated medical costs for UEMBMI patients with schizophrenia in Tianjin,China / 中国心理卫生杂志

Objective:To describe antipsychotic medication prescription patterns and estimate the associated costs for patients with schizophrenia in Tianjin,China. Methods:Data were 30%random sampling from the Tianjin Urban Employee Basic Medical Insurance (UEBMI)database. Adult patients with≥ 1 diagnosis of schizophrenia, antipsychotics prescribed at the first diagnosis of schizophrenia (index date),and 12-month continuous enrollment after the first antipsychotic prescription (follow-up period)between 2008 and 2010 were included. The classes and number of antipsychotics patients prescribed at index date and patterns of antipsychotics patients maintained/changed during the study period were described. The total direct medical costs were also estimated. Results:Among 2125 patients with schizophrenia,1739 (81. 8%)prescribed with antipsychotic medication prescriptions were in-cluded. At the index date,1461 (84. 0%)of the patients prescribed with one antipsychotic medication,278 (16. 0%)with more than two antipsychotics,and 747 (43. 0%)were prescribed with first-generation antipsychot-ics,813 (46. 8%)with second-generation antipsychotics and 179 (10. 2%)with both. During the following 12 months,1387 (79. 8%)patients remained on the index antipsychotic class. The total cost for 1739 patients was (12498. 9 ±14575. 2)CNY. The total direct medical cost was significantly lower for patients only prescribed with second-generation antipsychotics compared with ones only with first-generation antipsychotics [(9064. 1 ±13209. 8) CNY vs. (1 1928. 6 ±13767. 4)CNY,P<0. 001 ]. In addition,the cost for patients prescribed with first-generation and second-generation antipsychotics was 18821. 8 ±15702. 7 CNY. Conclusion:Majority of patients are prescribed with monotherapy,and tend to stay with one antipsychotic medication class. The total medical cost for patients with second-generation antipsychotic medications is lower than first-generation ones.

Survey on the adherence of patients with schizophrenia as assessed by selected psychiatrists in the Philippines - ADHHES data

OBJECTIVES:The main objectives of the Adherence in Schizophrenia (ADHES) survey in the Philippines were to: (1) describe the insights of Filipino psychiatrists on the level of adherence to treatment of patients with schizophrenia; and (2) to identify possible main challenges for treatment adherence in schizophrenia.METHODOLOGY:The 2012 ADHES Asia Pacific (APAC) survey was a questionnaire-based survey with 4,661responding psychiatrists (24% of recipients) in 13 countries in the Asia-Pacific region, which was administered from January 2012 to April 2012. In the Philippines (n=17), the survey was conducted between March and April 2012 and distributed to psychiatrists by Janssen personnel. The 20-item questionnaire was devised to ascertain psychiatrists' preferred methods of assessing perceptions of the levels of adherence, reasons for non-adherence to treatment in schizophrenia patients, their perceptions of the levels of adherence, reasons for non-adherence and strategies to improve adherence. Gender, age and practice setting of the psychiatrists were also collected for analysis.RESULTS:A total of 71 psychiatrists responded to the ADHES Survey in the Philippines. The most common approaches used by the psychiatrists in assessing adherence to prescribed doses were asking an informant (e.g. relative, friend, caregiver) (96%) and asking the patient directly (94%). About 48% of the patients were "fully-adherent" or took at least 90% of prescribed doses as assessed by the psychiatrists who were included in the survey. Meanwhile, 23% of the patients were "non-adherent" or took 30% of prescribed doses. According to the psychiatrists, the most were lack of insight (28%) and cognitive impairment (24%). However, the most common reason for stopping medication among the respondents' patients was due to insufficient efficacy of the antipsychotic or having experienced psychotic symptoms with the medication they are taking (30%). Lastly, the most preferred pharmacological strategies used by the respondents to address an adherence problem in patients with schizophrenia were switching to a long-acting anti psychotic medication (27%) and switching to a different oral antipsychotic (23%).CONCLUSION:Partial or non-compliance to medication is a serious issue in schizophrenia, and insight into illness in schizophrenia, and insight into illness in schizophrenia is the most important reason for treatment non-adherence. Thu, there is a need to continuously assess the level of insight in patients with schizophrenia and institute more pro-active interventions such as direct-observation treatment for oral medications or long-acting injectable antipsychotics. The more wide-spread use objective assessments of medication  compliance can also be explored.  

Disfunção pré-frontoparietal durante o processamento de informação visuoauditiva em pacientes idosos com esquizofrenia crônica e efeitos da medicação / Parieto-prefrontal dysfunction during visuo-auditory information processing in elderly, chronic schizophrenic patients and medication effects

OBJETIVOS: Em pacientes com primeiro episódio de esquizofrenia, estudos com ressonância magnética funcional (RMf) têm demonstrado disfunção pré-frontoparietal durante estimulação acústica e visual. O objetivo do presente estudo foi investigar a rede pré-frontoparietal em pacientes idosos com esquizofrenia utilizando o mesmo paradigma. Adicionalmente, foram presumidos efeitos favoráveis na ativação cerebral pelo antipsicótico atípico clozapina em comparação a neurolépticos típicos. MÉTODOS: Foram investigados 18 pacientes com esquizofrenia crônica e 21 controles saudáveis idosos. Nove pacientes com esquizofrenia haviam sido medicados com clozapina e nove haviam recebido neurolépticos típicos por décadas. Concomitantemente às avaliações com escalas psicopatológicas e neuropsicológicas foi utilizado um paradigma de estimulação auditiva e visual em um aparelho de ressonância magnética de 1,5 Tesla para investigar a resposta BOLD em diferentes áreas cerebrais. RESULTADOS: Comparados a controles saudáveis, os pacientes com esquizofrenia apresentaram diminuição na ativação cerebral nos córtices pré-frontal e parietal, assim como no giro do cíngulo anterior medial. Nessas regiões, os pacientes medicados com clozapina apresentaram resposta BOLD aumentada em comparação aos pacientes tratados com neurolépticos típicos. DISCUSSÃO: O presente estudo confirmou a presença de distúrbios na rede pré-frontoparietal em pacientes idosos com esquizofrenia, apontando assim para a preservação de déficits de ativação cerebrais e a influência de distúrbios do desenvolvimento neural em esquizofrenia crônica até a velhice. CONCLUSÃO: O antipsicótico atípico clozapina parece facilitar a ativação de áreas cerebrais mesmo em pacientes idosos com esquizofrenia crônica.

OBJECTIVES: In first-episode schizophrenia patients, functional magnetic resonance imaging (fMRI) has shown prefronto-parietal dysfunction during acoustic and visual stimulation. The aim of this study was to investigate the prefronto-parietal network in elderly schizophrenia patients using the same paradigm. Additionally, we hypothesized favourable effects on brain activation by the atypical antipsychotic clozapine compared to typical neuroleptics. METHODS: We investigated 18 elderly, chronic schizophrenia patients and 21 elderly healthy controls. Nine schizophrenia patients had been medicated with clozapine and 9 had been receiving typical neuroleptics over decades. In addition to assessments with psychopathological and neuropsychological rating scales we used an acoustic and visual stimulation paradigm in a 1.5 Tesla MRI scanner to investigate BOLD-response in different brain areas. RESULTS: Compared to healthy controls schizophrenia patients showed decreased brain activation in the prefrontal and parietal cortex as well as medial anterior cingulate gyrus compared to healthy controls. In these regions, patients medicated with clozapine showed increased BOLD-response compared to patients treated with typical neuroleptics. DISCUSSION: Our study confirmed prefronto-parietal network disturbances in elderly schizophrenia patients thus pointing to the preservation of brain activation deficits and the influence of neurodevelopmental disturbances in chronic schizophrenia until old-age. CONCLUSION: The atypical antipsychotic clozapine seems to facilitate brain activation even in elderly, chronic schizophrenia patients.

Avaliação de aspectos cognitivos em homens portadores de esquizofrenia em tratamento com haloperidol ou clozapina / Cognitive aspects evaluation of schizophrenic men under haloperidol or clozapine treatment

OBJETIVO: Avaliar, sob o ponto de vista psicológico, aspectos cognitivos de pacientes portadores de esquizofrenia associados ao tipo de medicamento antipsicótico em uso. MÉTODOS: Participaram dois grupos: no grupo 1 os pacientes em tratamento com haloperidol (n = 14) e no 2 aqueles em tratamento com clozapina (n = 16). Ambos os grupos eram formados por indivíduos com esquizofrenia em tratamento psiquiátrico ambulatorial no Hospital de Clínicas de Porto Alegre (HCPA), cuja faixa etária variou entre 18 e 59 anos. Foram usados como instrumentos o Operational Checklist for Psychotic Illness (OPCRIT) para definição do diagnóstico de esquizofrenia e a técnica de Rorschach. Também se realizou a análise de variância (ANOVA) seguida do teste de Bonferroni, com nível de significância de p < 0,05 sobre os dados do teste de Rorschach. RESULTADOS: O grupo 1 apresentou F+ < 80 por cento; FK < KF + K; FC < CF + C. O grupo 2 apresentou F+ > 80 por cento; FK = KF + K; FC > CF + C. Ambos os grupos apresentaram escore de forma (sigmaF) na faixa clínica considerada normal. CONCLUSÃO: Os resultados do Rorschach permitem inferir que os pacientes medicados com clozapina apresentam indicativos de capacidade de produção e adaptação à tarefa, controle pelo uso da inteligência sobre impulsos e instintos, capacidade para suportar frustração e funcionamento do raciocínio lógico em melhores condições do que os pacientes medicados com haloperidol.

OBJECTIVE: Evaluate from a psychological point of view cognitive aspects of schizophrenic patients, associated with the antipsychotic medicine type taken. METHODS: The study analyzed three groups: group 1 patients medicated with haloperidol (n = 14); group 2 - patients medicated with clozapine (n =16). Groups 1 and 2 were schizophrenic men under psychiatric treatment at Hospital de Clínicas de Porto Alegre (HCPA). The age of all subjects ranged from 18 to 59 years. The following tools were used in the study: the Operational Checklist for Psychotic Illness (OPCRIT) to diagnose schizophrenia, and the Rorschach technique. The Rorschach data was subject to a variance analysis (ANOVA) followed by a Bonferroni test with a confidence interval of p < 0.05. RESULTS: Group 1 presented F+ < 80 percent; FK < KF + K; FC < CF + C. Group 2 presented F+ > 80 percent; FK = KF + K; FC > CF + C. Both groups presented sigmaF within the clinical range considered normal. CONCLUSION: The results show that patients medicated with clozapine present a relative capacity to participate on activities and tasks. Besides, they can control impulses and instincts by intellectual means in a superior fashion than patients medicated with haloperidol. Finally, it was also concluded that clozapine users present a greater ability to tolerate frustration, and a better general intellectual performance than haloperidol users.