[Clinical guidelines for the management of schizophrenia (ΙΙ): Community service-level interventions and the role of Primary Care].

Schizophrenia is one of the most disabling disorders globally, with a significant impact on the professional, social and personal functioning of those affected. Mortality rates are estimated to be 2-2.5 times greater than in the general population attributable to not only suicide but also physical illnesses, such as cardiovascular, metabolic and infectious diseases. Patients with schizophrenia have increased needs for health services which vary according to the stage of the illness and the way the disorder affects the patient. A significant part of the costs of treating patients with schizophrenia is attributed to the health service costs, both to address the disorder itself and its wider effects. In 2015 the National Clinical Guidelines for the management of schizophrenia were formulated by a Working Group that was set up by the Greek Ministry of Health. In this article, a summary of the recommendations (as included in the National Clinical Guidelines) is presented, describing the role of primary care and community mental health services in the management of schizophrenia. The NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia was utilized as the main guide to develop the Greek National Guidelines . In addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA, 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists, 2005), as well as other relevant sources were also used. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. Special effort was made to adapt the international experience to the current Greek landscape with its constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. The proposals aim to contribute to the efficient implementation of the provision of community mental health services for patients suffering from psychotic disorders, focusing in particular on: (a) the role of primary health care services and the role of family physician in the treatment of schizophrenia; (b) the cooperation and coordination between mental health services and primary care services in order to ensure continuity of care (c) designing services that deliver evidence-based interventions,thus ensuring that a larger proportion of the population receives interventions with documented effectiveness in the treatment of schizophrenia, in the least restrictive environment. A particular emphasis is placed on services that are expected to reduce the need for hospitalization, such as crisis intervention services, community interventions aimed at maintaining and continuing the treatment of difficult patients who tend to be lost to follow up from services and early intervention services in psychosis.

[Clinical guidelines for the management of schizophrenia: Pharmacological and psychological interventions (III)].

In 2014 a Working Group was set up by the Greek Ministry of Health, with the objective of formulating Clinical Guidelines for the management of schizophrenia which include recommendations for the pharmacological and the psychosocial treatment of schizophrenia. This Working Group utilized the NICE Guideline (National Institute of Clinical Excellence 2014) for the management of Psychosis & Schizophrenia as the main guide in the development of the Greek guidelines, and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA, 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005), as well as other relevant sources. Furthermore, the Hellenic Psychiatric Association (HPA) established an Expert Committee that contributed with its observations to this exercise. With regard to the pharmacological management of schizophrenia, recommendations for initiating and monitoring drug therapy, treating the first psychotic episode as well as treating the acute as well as the maintenance phase of the illness are included. Also included is the management of treatment resistance as well the management of dual diagnosis patients and rapid tranquilization. The guidelines for the psychological treatment of schizophrenia include general recommendations covering all different types of interventions but also specific suggestions for the psychological interventions that should be utilized in the treatment of schizophrenia. In this article the summary recommendations (incorporating the Hellenic Psychiatric Association comments) regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia are presented.

[Clinical guidelines for the management of schizophrenia:Aims and limitations (Ι)].

The initiative for the development of national treatment guidelines, dates back to the '90s. In Greece, however, National Clinical Guidelines for the management of schizophrenia were first formulated in 2014 when a Working Group was set up for this purpose by the Greek Ministry of Health. The objective of this Working Group was to provide evidence-based recommendations covering the pharmacological and psychosocial treatment of schizophrenia as well as the development of appropriate treatment services. The Working Group utilized the NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia as the main guide to develop the Greek National Guidelines , and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005) , as well as other relevant sources. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. A special effort was made to adapt the international experience to the current Greek landscape with the constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. After the preparation of the draft guidelines, a thorough consultation followed with the relevant stakeholders, including mental health professionals, user associations and representatives of the Greek Ombudsman. Additionally, the Hellenic Psychiatric Association established an Expert Committee in Spring 2016, that contributed with its observations to the final exercise. This article will be followed by two further publications (incorporating the Hellenic Psychiatric Association comments) which include: (1) the summary recommendations regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia, and (2) the summary recommendations regarding: (a) the role of primary health care service and the role of the family physician in the treatment of schizophrenia (b) the summary recommendations regarding continuity of care and c) the summary recommendations regarding community interventions with documented effectiveness in the treatment of schizophrenia.