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Prevención de recaídas en la esquizofrenia: actitudes de los neurólogos-psiquiatras

Published online by Cambridge University Press:  12 May 2020

J. D. Bergiannaki
Affiliation:
Instituto Universitario de Investigación de la Salud Mental, Hospital Eginition, Vas. Sophias Ave. 72-74, GR11528Atenas, Grecia
J. Hatzimanolis
Affiliation:
Instituto Universitario de Investigación de la Salud Mental, Hospital Eginition, Vas. Sophias Ave. 72-74, GR11528Atenas, Grecia
J. Liappas
Affiliation:
Instituto Universitario de Investigación de la Salud Mental, Hospital Eginition, Vas. Sophias Ave. 72-74, GR11528Atenas, Grecia
P. N. Sakkas
Affiliation:
Instituto Universitario de Investigación de la Salud Mental, Hospital Eginition, Vas. Sophias Ave. 72-74, GR11528Atenas, Grecia
C. N. Stefanis
Affiliation:
Instituto Universitario de Investigación de la Salud Mental, Hospital Eginition, Vas. Sophias Ave. 72-74, GR11528Atenas, Grecia
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Resumen

Las elevadas tasas globales de recaída observadas en la esquizofrenia se atribuyen a varias causas. Un factor importante que influye en la prevención satisfactoria de la recaída es la falta de estrategias de tratamiento coherentes entre los médicos, especialmente los neurólogos-psiquiatras. Se pidió a casi un tercio de los miembros de la Sociedad Helénica de Neurología y Psiquiatría que cumplimentaran anónimamente un cuestionario estructurado sobre sus actitudes de tratamiento y tácticas de prescripción con respecto a los pacientes esquizofrénicos tanto después del primer episodio esquizofrénico como después de múltiples episodios. La mayoría de los neurólogos-psiquiatras griegos parecen adoptar hábitos de prescripción que se aproximan a las normas internacionales actuales para la prevención de la recaída esquizofrénica. Sus actitudes con respecto al tratamiento y la prevención de recaídas para el primer episodio esquizofrénico y la primera recaída se determinan a partir de múltiples factores. Estos son: las tasas esperadas de recaída después del primer episodio, la prevalencia esperada de efectos secundarios extrapiramidales después de un tratamiento neuroléptico a largo plazo, el cumplimiento esperado del tratamiento del paciente después del primer episodio, la experiencia del médico con el tratamiento de esquizofrénicos y, por último, el conocimiento de las publicaciones actuales sobre la materia. Estos resultados apuntan a la necesidad de educación continuada, especialmente de los profesionales de salud mental más jóvenes y los que trabajan en el sector privado, que se dirija a la cuestión del riesgo real de desarrollar efectos secundarios a partir del tratamiento. A su debido tiempo, podrían producirse beneficios para el ejercicio cotidiano de la psiquiatría y el cumplimiento de los pacientes del tratamiento.

Type
Artículo Original
Copyright
Copyright © European Psychiatric Association 2001

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References

Bibliografía

Angermeyer, MC, Siara, CS. Effects on assassination attempts on Lafontaine and Schauble on public opinión about psychiatric patients. Part 2: 1991 development. Nervenarzt 1994; 65 Suppl 382: 4956.Google ScholarPubMed
Baldessarini, RJ, Cohén, BM, Teicher, MH. Significance of neuroleptic dose and plasma levels in the pharmacological treatment of psychoses. Arch Gen Psychiatry 1988; 45: 7991.CrossRefGoogle Scholar
Baüml, J, Kissling, W, Meurer, C, Wais, A, Lauter, H. Informationszentrierte Angehórigengruppen zur Com-plianceverbesserung bei schizophrenen Patienten. Psychiat Prax 1991; 18: 4554.Google Scholar
Bleuler, M. The schizophrenic disorders-long-term patient and family studies. New Haven: Yale University Press; 1978.Google Scholar
Citrome, L. New antipsychotic medications: what advantages do they offer? Postgrad Med 1997; 101: 207–10.CrossRefGoogle ScholarPubMed
Crow, TJ, McMillan, JF, Johnson, AL, Johnstone, EC. The Northwick Park study of first episodes of schizophrenia: II. A randomized controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry 1986; 148: 120–7.Google Scholar
Davis, JM. Overview: maintenance of therapy in psychiatry. Am J Psychiatry 1975; 132: 1237–45.Google Scholar
Davis, JM. Antipsychotic drugs. In: Kaplan HI, Freedman AM, Sadock BJ, Eds. Comprehensive textbook of psychiatry. 3rd ed. Baltimore: Williams and Wilkins; 1980. p. 2257-89.Google Scholar
Davis, J. Maintenance medication. In: Barnes TRE, Ed. Depot neuroleptics: a consensus. London: Mediscript; 1988. p. 47-52.Google Scholar
Denker, SJ, May, PRA. The treatment of acute psychosis. Copenhagen: Lundbeck; 1986.Google Scholar
Fenton, WS, Blyler, CR, Heinssen, RK. Determinants of medication compliance in schizophrenia: empirical and clinical findings. Schizophr Bull 1997; 23: 637–51.CrossRefGoogle ScholarPubMed
Fleischhacker, WW, Meise, U. The current status of maintenance treatment in schizophrenia. In: Kissling W, Ed. Guidelines for neuroleptic relapse prevention in schizophrenia. New York: Springer-Verlag; 1991. p. 13-5.Google Scholar
Gabel, W. Towards the improvement of compliance: the significance of psycho-education and new antipsychotic drugs. Int Clin Psychopharmacol 1997; 12 Suppl 1: S37S42.CrossRefGoogle Scholar
Gabel, W, Pietzcker, A. Indikation zur neuroleptischen Langzeitmedikation — standardverfahren oder individual prognostisch geleitete Intervention? Nervenarzt 1983; 54: 467–76.Google Scholar
Gabel, W, Pietzcker, A. One-year outcome of schizophrenic patients — the interaction of chronicity and neuroleptic treatment. Pharmacopsychiatry 1985; 18: 235–9.CrossRefGoogle Scholar
Gabel, W, Marder, S. Conclusions and treatment recommendations for the acute episode in schizophrenia. Int Clin Psychopharmacol 1996; 11 Suppl 2: 93100.CrossRefGoogle Scholar
Gerlach, J, Casey, DE. Tardive dyskinesia. Acta Psychiatr Scand 1988; 77: 369–78.CrossRefGoogle ScholarPubMed
Gjerris, A, Kissling, W. Concluding remarks. Acta Psychiatr Scand 1994; 89 Suppl 382: 93.CrossRefGoogle Scholar
Gmiir, M, Tschopp, A. Die Behandlungskontinuitat bei schizophrenen Patienten in der Ambulanz. Eine Fünfjahresnachuntersuchung. Nervenarzt 1988; 59: 727–30.Google Scholar
Guenther, V, Meise, U. Compliance — Ein Komplexes Problem. Wien Med Wochenschr 1990; 140: 265–9.Google Scholar
Gunderson, JG, Mosher, LR. The cost of schizophrenia. AmJ Psychiatry 1975; 132: 901–6.Google ScholarPubMed
Hall, W, Goldstein, G, Andrews, G, Lapsley, H, Bartels, R, Silove, D. Estimating the economic costs of schizophrenia. Schizophr Bull 1985; 11: 598610.CrossRefGoogle ScholarPubMed
Hogarty, GE, Goldberg, SC, Collaborative, Study Group. Drug and sociotherapy in the aftercare of schizophrenic patients: one year relapse rates. Arch Gen Psychiatry 1974; 28: 5464.CrossRefGoogle Scholar
Hogarty, GE. Resistance of schizophrenic patients to social and vocational rehabilitation. In: Dencker SJ, Kulhanek F, Eds. Treatment resistance in schizophrenia. Wiesbaden: Braunschweig; 1988.Google Scholar
Hornung, WP, Kieserg, A, Feldmann, R, Buchkremer, G. Psychoeducational training for schizophrenic patients: background, procedure and empirical findings. Patient Educ Couns 1996; 29: 257–68.CrossRefGoogle ScholarPubMed
Janicak, PG, Davis, JM. Antipsychotic dosing strategies in acute schizophrenia. Int Clin Psychopharmacol 1996; 11 Suppl 2: 3540.CrossRefGoogle ScholarPubMed
Johnstone, EC, Crow, TJ, Johnson, AL, Macmillan, JF. The Northwick Park study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission. Br J Psychiatry 1986; 148: 115–20.Google ScholarPubMed
Johnstone, EC, Geddes, J. How high is the relapse rate in schizophrenia? Acta Psychiatr Scand 1994; 89 Suppl 382: 610.CrossRefGoogle Scholar
Kane, JM. Problems of compliance in the outpatient treatment of schizophrenia. J Clin Psychiatry 1983; 1: 36.Google Scholar
Kane, JM. Compliance issues in outpatient treatment. J Clin Psychopharmacol 1985; 5: 225–75.CrossRefGoogle ScholarPubMed
Kane, JM. Treatment of schizophrenia. Schizophr Bull 1987; 13: 133–56.CrossRefGoogle ScholarPubMed
Kane, JM. Dosage and route of administration of neuroleptic drugs during different phases of a schizophrenic illness. In: Kissling W, Ed. Guidelines for neuroleptic relapse prevention in schizophrenia. New York: Springer-Verlag; 1991. p. 8593.Google Scholar
Kane, JM, Rifkin, A, Quitkin, F, Naya, D, Ramos-Lorenzi, J. Fluphenazine versus placebo in patients with remited acute first episode schizophrenia. Arch Gen Psychiatry 1982; 39: 70–3.CrossRefGoogle Scholar
Kane, JM, Woerner, M, Borenstein, M, Wegner, J, Lieberman, J. Integrating incidence and prevalence of tardive dyskinesia. Psychopharmacol Bull 1986; 22: 254–8.Google ScholarPubMed
Kissling, W. Depot neuroleptics — a step forward? Consensus regarding indication for prophylactic neuroleptic treatment — necessary, but unattainable? In: Barnes TRE, Ed. Depot neuroleptics: a consensus. London: Mediscript; 1988. p. 41-6.Google Scholar
Kissling, W, Ed. Guidelines for neuroleptic relapse prevention in schizophrenia. Berlín: Springer-Verlag; 1991.CrossRefGoogle Scholar
Kissling, W. Compliance, quality assurance and standards for relapse prevention in schizophrenia. Acta Psychiatr Scand 1994; 89 Suppl 382: 1624.CrossRefGoogle Scholar
Kissling, W, Kane, JM, Barnes, TRE, Dencker, SJ, Fleischhacker, WW, Goldstein, MJ, et al. Guidelines for neuroleptic relapse prevention in schizophrenia: towards a consensus view. In: Kissling W, Ed. Guidelines for neuroleptic relapse prevention in schizophrenia. New York: Springer-Verlag; 1991. p. 155-63-CrossRefGoogle Scholar
Lehman, AF, Steinwachs, DM. Survey Co-Investigators of the PORT Project. Patterns of usual care for schizophrenia: initial results from the schizophrenia patient outcomes research team (PORT) client survey. Schizophr Bull 1998; 24: 1120.Google Scholar
Lewandowski, L, Buchkremer, G. Therapeutische Gruppenarbeit mit Angehórigen schizphrener Patienten. Z Klin Psychol 1988; 17: 210–24.Google Scholar
Mantonakis, J, Markidis, M, Kontaxakis, V, Liakos, A. A scale for detection of negative attitude towards medication among relatives of schizophrenic patients. Acta Psychiatr Scand 1985; 2: 186–9.CrossRefGoogle Scholar
Marsden, CD. Is tardive dyskinesia a unique disorder? In: Casey DE, Chase TN, Christensen AV, Gerlach J, Eds. Dyskinesia - research and treatment. (Psychopharmaco-logy series, vol. 2). Berlin: Springer; 1985.Google Scholar
Marder, SR. The role of dosage and plasma levels in neuroleptic relapse prevention. Acta Psychiatr Scand 1994; 89 Suppl 382: 25–7.CrossRefGoogle Scholar
Marder, SR. Pharmacological treatment strategies in acute schizophrenia. Int Clin Psychopharmacol 1996; 11 Suppl 2: 2934.CrossRefGoogle ScholarPubMed
Maurer, K, Biehl, H. Klinikaufenthalte und produktive Rückfalle bei ersterkrankten Schizophrenen. Nervenheil-kunde 1988; 7: 279–90.Google Scholar
McEnvoy, JP, Hogerty, GE, Steingard, S. Optimal dose of neuroleptics in acute schizophrenia: a controlled study of the neuroleptic threshold and higher haloperidol dose. Arch Gen Psychiatry 1991; 48: 739–45.CrossRefGoogle Scholar
McGlashan, TH. A selective review of recent North América long-term follow-up studies of schizophrenia. Schizophr Bull 1988; 14: 515–42.CrossRefGoogle ScholarPubMed
Meise, U, Fleischhacker, WW. Perspectives on treatment needs in schizophrenia. Br J Psychiatry 1996; 168 Suppl 29: 916.CrossRefGoogle Scholar
Miiller, P, Ed. Zur Rezidivprophylaxe Schizophrener Psychosen Stuttgart: Enke; 1982.Google Scholar
Pietzcker, A. Neuroleptische Langzeit-Medikation in der ambulanten Behandlung schizophren Kranker. Hamburg: Promonta Schriften; 1987.Google Scholar
Rabiner, CJ, Wegner, JT, Kane, JM. Outcome study of first episode psychosis: I. Relapse rates after one year. Am J Psychiatry 1986; 143: 1155–8.Google Scholar
Rice, DP, Kelman, S, Miller, LS. The economic burden of mental illness. Hosp Community Psychiatry 1992; 43: 1227–32.Google ScholarPubMed
Rifkin, A. A historical review of the adverse reactions to neuroleptic agents. J Clin Psychiatry 1987; 3 Suppl 48: 6.Google Scholar
Sheitman, BB, Lee, H, Strauss, R, Lieber, JA. The evaluation and treatment of first-episode psychosis. Schizophr Bull 1997; 23: 653–61.CrossRefGoogle ScholarPubMed
Shepherd, M, Watt, D, Falloon, I, Smeeton, N. The natural history of schizophrenia: a five-year-follow-up study of outcome and prediction in a representative sample of schizophrenia. Psychol Med Monogr Suppl 15. Cambridge: Cambridge University Press; 1989.Google Scholar
Tegeler, J. Maintenance neuroleptic treatment in schi In: Kissling W, Ed. Guidelines for neuroleptic relapse prevention in schizophrenia. New York: Springer-Verlag; 1991. p. 34-7.Google Scholar
Van, Putten T. Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 1974; 31: 6772.Google Scholar