Schizophrenia: quality of life and drug treatment

Dissolving fractured head (cropped)To recognize World Mental Health day and its focus on living with schizophrenia we‘ve taken a look at some recent research emphasizing quality of life and treatment for those affected by this chronic mental condition.

Seven adults out of every 1,000 have schizophrenia, with half of affected individuals not receiving appropriate care. Over 90% of untreated people are from low- and middle- income countries. The WHO Mental Health Gap Action Programme (mhGAP) aims to scale up services for mental disorders in these countries by ensuring proper care, psychosocial assistance and medication.

Quality of life

Living with schizophrenia affects daily life. A recent study from the UK, highlighted in the news, showed that delusion prone schizophrenic patients are less likely to wait for the best moment before making a decision. The affected individuals tend to rush to make choices in their everyday lives which results in unsuccessful outcomes. Therefore, these patients need to be educated on the consequences of reaching inadequate decisions.

homeless man (Rod Waddington) cropWith regard to schizophrenia in low- and middle- income countries, Vikram Patel has discussed research and capacity building. He also calls for advocacy to develop policies which will improve access to care for people living with mental disorders around the world, with a particular focus on those countries where the treatment gaps are the largest.

Improving care of mentally ill people in the developing world has been addressed lately in a cross sectional survey by Martin Prince and colleagues which demonstrates that psychosis is common in homeless people living on the street in Addis Ababa. This study suggests that strategies to improve conditions for the homeless in low-income countries should include treatment for mental disorders including schizophrenia. They authors conclude that:

“These countries should develop models of intervention with social engagement and family re-integration at their heart. However, what model of care should be implemented for this population in a low income country has to be defined”.

Treatment

Risperidone an atypical antipsychotic drug is one of the pharmacological therapies used for schizophrenic patients. Interestingly a retrospective association study of risperidone prescribing rates performed by Brian Godman and colleagues shows prescribing of generic risperidone has decreased compared with other atypical antipsychotic drugs in Western Europe. However, utilization and price of the drug vary across countries, suggesting a need for increased prescribing and reduced price. Pills (Flickr, e-MagineArt.com)

Conversely, Michael Berk and colleagues argue for a balance between cheapest drug use and optimal tailored care to ensure beneficial patient outcomes when treating with a broad range of atypical antipsychotics. The authors highlight caution that:

Mandating switching to a generic atypical antipsychotic without any corresponding clinical indication may result in increased risk of relapse, reduced adherence, poorer outcomes and greater ultimate health care costs.

Overall, the studies described above show treatment of individuals affected by schizophrenia in low- and middle- income countries is greatly needed to help improve their quality of life. Whereas in high income countries in Western Europe a personalized drug therapy approach will ensure better management of individuals suffering from this severe mental condition.

You can view a collection of BioMed Central and Springer articles on schizophrenia at springer.com/schizophrenia

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