Epidemiology and Treatment Guidelines of Negative Symptoms in Schizo-phrenia in Central and Eastern Europe: A Literature Review.

AIM: To gather and review data describing the epidemiology of schizophrenia and clinical guidelines for schizophrenia therapy in seven Central and Eastern European countries, with a focus on negative symptoms. Methods : A literature search was conducted which included publications from 1995 to 2012 that were indexed in key databases. Results : Reports of mean annual incidence of schizophrenia varied greatly, from 0.04 to 0.58 per 1,000 population. Lifetime prevalence varied from 0.4% to 1.4%. One study reported that at least one negative symptom was present in 57.6% of patients with schizophrenia and in 50-90% of individuals experiencing their first episode of schizophrenia. Primary negative symptoms were observed in 10-30% of patients. Mortality in patients with schizophrenia was greater than in the general population, with a standardized mortality ratio of 2.58-4.30. Reasons for higher risk of mortality in the schizophrenia population included increased suicide risk, effect of schizophrenia on lifestyle and environment, and presence of comorbidities. Clinical guidelines overall supported the use of second-generation antipsychotics in managing negative symptoms of schizophrenia, although improved therapeutic approaches are needed. Conclusion : Schizophrenia is one of the most common mental illnesses and poses a considerable burden on patients and healthcare resources alike. Negative symptoms are present in many patients and there is an unmet need to improve treatment offerings for negative symptoms beyond the use of second-generation antipsychotics and overall patient outcomes.

Therapeutic adherence to osteoporosis treatment.

OBJECTIVE: Adherence of patients to therapy is a major determinant of therapeutic success, which is not included in most clinical studies. This is especially true for chronic diseases with few subjective symptoms, such as osteoporosis. The aim of our study was to describe and to analyze the therapeutic adherence to several widely used anti-osteoporotic medications in real-world medicine in Slovakia. METHODS: Using a retrospective approach, data about drug prescriptions for 8,223 patients from 3 consecutive years were analyzed regarding compliance and persistence. Compliance was measured as medication possession ratio-ratio between the supply of the drugs in the treatment time according to the prescriptions and the time of observation. Persistence was assessed as the percentage of patients who used the drug without a gap for the given time period. RESULTS: The average compliance was 70%, 59%, and 4% for 6, 12, and 24 months, respectively. Average persistence was very low with 54%, 42%, and 22% for 6, 12, and 24 months, respectively. Total average persistence was only 9.8 months. Medications with lower frequency of application tended to be associated with higher adherence. CONCLUSION: In conclusion, the therapeutic adherence to anti-osteoporotic treatments varies between the available drugs and drug regimens. In general, the adherence is very low but comparable to previously published studies from other countries. This variability of adherence should be considered in clinical decision making together with the variability of therapeutic efficiency found in clinical studies.

Preferences of patients receiving bisphosphonates--how to influence the therapeutic adherence.

BACKGROUND: Therapeutic adherence determines the efficacy of treatments in the clinical practice. Especially in chronic asymptomatic diseases large differences exist between therapeutic success in clinical studies and clinical practice. The treatment of osteoporosis using bisphosphonates is considerably influenced by the low adherence of patients due to the complicated drug application. SUBJECTS AND METHODS: The VIVA study analyzed the preferences of 1635 patients with osteoporosis in Slovakia using a simple questionnaire. RESULTS: The majority of patients--76% preferred the monthly regime of bisphosphonate therapy, 22% of patients preferred the weekly regimen and only a minority--2% preferred daily application. CONCLUSION: The results are in agreement with results of the BALTO study in the USA and the SWIFT study in Switzerland showing a clear preference to the monthly regime. The preferences of patients were motivated by various different aspects of improved quality of life, which is offered by the new bisphosphonate regimen once monthly.