Brugnoli Roberto, Rapinesi Chiara, Kotzalidis Georgios D, Marcellusi Andrea, Mennini Francesco S, De Filippis Sergio, Carrus Dario, Ballerini Andrea, Francomano Antonio, Ducci Giuseppe, Del Casale Antonio, Girardi Paolo
NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.
Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Italy.
Riv Psichiatr. 2016 Mar-Apr;51(2):47-59. doi: 10.1708/2246.24194.
Schizophrenia is a severe mental disease that affects approximately 1% of the population with a relevant chronic impact on social and occupational functioning and daily activities. People with schizophrenia are 2-2.5 times more likely to die early than the general population. Non-adherence to antipsychotic medications, both in chronic and first episode schizophrenia, is one of the most important risk factors for relapse and hospitalization, that consequently contributes to increased costs due to psychiatric hospitalization. Atypical long-acting injectable (LAI) antipsychotics can improve treatment adherence and decrease re-hospitalization rates in patients with schizophrenia since its onset. The primary goals in the management of schizophrenia are directed not only at symptom reduction in the short and long term, but also at maintaining physical and mental functioning, improving quality of life, and promoting patient recovery.
To propose a scientific evidence-based integrated model that provides an algorithm for recovery of patients with schizophrenia and to investigate the effectiveness and safety of antipsychotics LAI in the treatment, maintenance, relapse prevention, and recovery of schizophrenia.
After an accurate literature review we identified, collected and analyzed the crucial points in taking care schizophrenia patients, through which we defined the steps described in the model of management and the choice of the better treatment option. Results. In the management model we propose, the choice of a second generation long acting antipsychotic, could allow from the earliest stages of illness better patient management, especially for young individuals with schizophrenia onset, a better recovery and significant reductions of relapse and health care costs. LAI formulations of antipsychotics are valuable, because they help patients to remain adherent to their medication through regular contact with healthcare professionals and to prevent covert non-adherence.
The proposed schizophrenia model of management could allow better patient management and recovery, in which the treatment with LAI formulation is a safe and effective therapeutic option. This new therapeutic approach could change the cost structure of schizophrenia by decreasing costs with efficient economic resource allocation guaranteed from efficient diagnostic and therapeutic pathways.
精神分裂症是一种严重的精神疾病,影响着约1%的人口,对社会和职业功能以及日常活动有着重大的慢性影响。精神分裂症患者早逝的可能性比普通人群高2至2.5倍。在慢性和首发精神分裂症中,不坚持服用抗精神病药物是复发和住院的最重要风险因素之一,这进而导致精神科住院费用增加。非典型长效注射用(LAI)抗精神病药物自问世以来,可提高精神分裂症患者的治疗依从性并降低再住院率。精神分裂症管理的主要目标不仅在于短期和长期减轻症状,还在于维持身心功能、提高生活质量以及促进患者康复。
提出一种基于科学证据的综合模型,该模型提供精神分裂症患者康复的算法,并研究LAI抗精神病药物在精神分裂症治疗、维持、预防复发及康复中的有效性和安全性。
在进行准确的文献综述后,我们确定、收集并分析了照顾精神分裂症患者的关键点,据此定义了管理模型中所述的步骤以及更好治疗方案的选择。结果。在我们提出的管理模型中,选择第二代长效抗精神病药物,可在疾病的最早阶段实现更好的患者管理,尤其是对于首发精神分裂症的年轻个体,实现更好的康复,并显著降低复发率和医疗成本。抗精神病药物的LAI制剂很有价值,因为它们通过与医疗保健专业人员的定期接触帮助患者坚持服药,并防止隐性不依从。
所提出的精神分裂症管理模型可实现更好的患者管理和康复,其中LAI制剂治疗是一种安全有效的治疗选择。这种新的治疗方法可通过高效的诊断和治疗途径保证有效分配经济资源来降低成本,从而改变精神分裂症的成本结构。