Towards a framework for treatment effectiveness in schizophrenia

Georg Juckel; Andrea de Bartolomeis; Philip Gorwood; Sergey Mosolov; Luca Pani; Alessandro Rossi; Julio Sanjuan

doi:10.2147/NDT.S61672

Towards a framework for treatment effectiveness in schizophrenia

Neuropsychiatr Dis Treat. 2014 Sep 24:10:1867-78. doi: 10.2147/NDT.S61672. eCollection 2014.

Authors

Georg Juckel¹, Andrea de Bartolomeis², Philip Gorwood³, Sergey Mosolov⁴, Luca Pani⁵, Alessandro Rossi⁶, Julio Sanjuan⁷

Affiliations

¹ Department of Psychiatry, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany.
² Laboratory of Molecular Psychiatry and Unit of Treatment Resistant Psychosis, University School of Medicine of Naples Federico II, Napoli, Italy.
³ Groupe Hospitalier Sainte-Anne (CMME), Paris-Descartes University, Paris, France.
⁴ Moscow Research Institute of Psychiatry, Moscow, Russia.
⁵ Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy.
⁶ Università de L'Aquila, L'Aquila, Italy.
⁷ Clinic Hospital, Spanish Mental Health Network (CIBERSAM), University of Valencia, Valencia, Spain.

Abstract

Introduction: Prompt administration of antipsychotic treatment that is adhered to is essential for the optimal treatment of schizophrenia. Many patients have benefited from the advent of second-generation antipsychotics, which can offer good symptomatic control with reduced incidence of extrapyramidal symptoms, although with higher risk of metabolic side effects. It is unsurprising that accounts as to whether first- and second-generation antipsychotics differ in their efficacy vary, since treatment effectiveness is a broad notion and difficult to define.

Objectives: Numerous factors may be used to gauge treatment effectiveness and, while it has largely been defined in terms of improvements in four domains (symptoms of disease, treatment burden, disease burden, and health and wellness), the real-world clinical utility of this consensus is unclear. Therefore, this article aims to provide a framework that can aid psychiatrists in making assessments about treatment effectiveness.

Methods and results: A panel of 12 psychiatrists and psychopharmacologists convened to develop and propose an accessible and globally-applicable framework for assessing the effectiveness of antipsychotic treatments in patients with schizophrenia. Following presentation of a preliminary proposal to a wider group of psychiatrists from across Europe, it was refined into a framework comprising five domains: symptomatic remission and retention of treatment; affective symptoms; cognitive functioning; treatment satisfaction; and personal and social functioning - each of which is discussed in this article.

Conclusions: This article provides a framework that can aid psychiatrists in making assessments about treatment effectiveness. It is anticipated that the framework outlined here may contribute to improving clinical practice through the promotion of a patient-centered approach to the assessment of treatment effectiveness, using five specified domains, in patients with schizophrenia.

Keywords: antipsychotic; assessment scales; functioning; mental illness; satisfaction.