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      Psychiatrists’ perceptions of the clinical importance, assessment and management of patient functioning in schizophrenia in Europe, the Middle East and Africa

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          Abstract

          Background

          It has been estimated that as many as two thirds of patients with schizophrenia are unable to perform basic personal and social roles or activities. Occupational functioning and social functioning, as well as independent living, are considered as core domains of patient functioning. Improvement in patient functioning has also been recognized as an important treatment goal in guidelines and an important outcome by regulatory agencies. Nevertheless, information is lacking on how these aspects are being considered by psychiatrists across the world and how they are being assessed and managed.

          Methods

          The ‘Europe, the Middle East and Africa functioning survey’ was designed to canvas opinions of psychiatrists across these regions to ascertain their perceptions of the clinical importance, assessment and management of functioning amongst their patients with schizophrenia. The survey comprised 17 questions and was conducted from March to April 2011 in 42 countries. Data collected included the demographics of respondents and their opinions regarding personal and social functioning in patients with schizophrenia.

          Results

          Results were obtained from 4,163 clinicians. Psychiatrists estimated that more than two thirds (70%) of their patients with schizophrenia showed impaired or very poor levels of functioning. The majority of psychiatrists (92%) believed that personal and social functioning was an important treatment goal for patients with schizophrenia, and 91% believed it was an important goal for patients’ families. The majority of psychiatrists (55%) assess the personal and social functioning of their patient at each visit; however, 81% reported that they determine the level of functioning through clinical interview and not by using a specific assessment scale. To manage personal and social functioning in their patients, 26% of psychiatrists prefer pharmacological interventions, whereas 46% prefer psychosocial interventions.

          Conclusion

          Psychiatrists recognize that functioning is impaired/very poor in patients with schizophrenia, and there is still an important need to address functioning as a main treatment goal for patients with schizophrenia.

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          Most cited references35

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          Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomised clinical trial.

          René S Kahn, W. Fleischhacker, Han Boter … (2008)
          Second-generation antipsychotic drugs were introduced over a decade ago for the treatment of schizophrenia; however, their purported clinical effectiveness compared with first-generation antipsychotic drugs is still debated. We aimed to compare the effectiveness of second-generation antipsychotic drugs with that of a low dose of haloperidol, in first-episode schizophrenia. We did an open randomised controlled trial of haloperidol versus second-generation antipsychotic drugs in 50 sites, in 14 countries. Eligible patients were aged 18-40 years, and met diagnostic criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder. 498 patients were randomly assigned by a web-based online system to haloperidol (1-4 mg per day; n=103), amisulpride (200-800 mg per day; n=104), olanzapine (5-20 mg per day; n=105), quetiapine (200-750 mg per day; n=104), or ziprasidone (40-160 mg per day; n=82); follow-up was at 1 year. The primary outcome measure was all-cause treatment discontinuation. Patients and their treating physicians were not blinded to the assigned treatment. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN68736636. The number of patients who discontinued treatment for any cause within 12 months was 63 (Kaplan-Meier estimate 72%) for haloperidol, 32 (40%) for amisulpride, 30 (33%) for olanzapine, 51 (53%) for quetiapine, and 31 (45%) for ziprasidone. Comparisons with haloperidol showed lower risks for any-cause discontinuation with amisulpride (hazard ratio [HR] 0.37, [95% CI 0.24-0.57]), olanzapine (HR 0.28 [0.18-0.43]), quetiapine (HR 0.52 [0.35-0.76]), and ziprasidone (HR 0.51 [0.32-0.81]). However, symptom reductions were virtually the same in all the groups, at around 60%. This pragmatic trial suggests that clinically meaningful antipsychotic treatment of first-episode of schizophrenia is achievable, for at least 1 year. However, we cannot conclude that second-generation drugs are more efficacious than is haloperidol, since discontinuation rates are not necessarily consistent with symptomatic improvement.
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            Barriers to employment for people with schizophrenia.

            Douglas Leslie, Richard Keefe, K Hsiao … (2006)
            There is growing interest in identifying and surmounting barriers to employment for people with schizophrenia. The authors examined factors associated with participation in competitive employment or other vocational activities in a large group of patients with schizophrenia who participated in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, a multisite clinical trial comparing the effects of first- and second-generation antipsychotics. Baseline data on more than 1,400 patients with a diagnosis of schizophrenia were collected before their entry into the CATIE study. Multinomial logistic regression was used to examine the relationship between participation in either competitive employment or other vocational activities and sociodemographic characteristics, schizophrenia symptoms, neurocognitive functioning, intrapsychic functioning, availability of psychosocial rehabilitation services, and local unemployment rates. Altogether, 14.5% of the patients reported participating in competitive employment in the month before the baseline assessment, 12.6% reported other (noncompetitive) employment activity, and 72.9% reported no employment activity. Participation in either competitive or noncompetitive employment was associated with having less severe symptoms, better neurocognitive functioning, and higher scores on a measure of intrapsychic functioning that encompassed motivation, empathy, and other psychological characteristics. Competitive employment, in contrast to other employment or no employment, was negatively associated with receipt of disability payments as well as with being black. Greater access to rehabilitation services was associated with greater participation in both competitive and noncompetitive employment. Overall employment of persons with schizophrenia seems to be impeded by clinical problems, including symptoms of schizophrenia and poorer neurocognitive and intrapsychic functioning. However, participation in competitive employment may be specifically impeded by the potentially adverse incentives of disability payments and by race and may be promoted by the availability of rehabilitation services.
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              Social functioning as an outcome measure in schizophrenia studies.

              Robert Burns, D. Patrick (2007)
              Deficits in social functioning are a core feature of schizophrenia. A literature search of English language articles published between January 1990 and December 2006 was undertaken to identify: i) scales used most frequently to assess social functioning in schizophrenia; and ii) the most frequently used social functioning scales in randomized, controlled trials of antipsychotics. A further search (without time limits) examined their psychometric properties. A total of 301 articles employed social functioning scales in the assessment of schizophrenia. These contained 87 potentially relevant measures. Only 14 randomized, controlled studies of antipsychotic agents were identified that examined social functioning. Scales varied greatly in terms of measurement approach, number and types of domains covered and scoring systems. A striking lack of data on psychometric properties was observed. Limited consensus on the definition and measurement of social functioning exists. The Personal and Social Performance Scale is proposed as a useful tool in future research.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Gen Psychiatry
                Journal ID (iso-abbrev): Ann Gen Psychiatry
                Title: Annals of General Psychiatry
                Publisher: BioMed Central
                ISSN (Electronic): 1744-859X
                Publication date Collection: 2013
                Publication date (Electronic): 26 March 2013
                Volume: 12
                Page: 8
                Affiliations
                [1 ]CMME, Sainte-Anne Hospital, Paris-Descartes University, 100 rue de la Santé, Paris, Cedex 14, 75674, France
                [2 ]INSERM UMR894, Centre of Psychiatry and Neuroscience, 2ter rue d'Alesia, Paris 75014, France
                [3 ]Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
                [4 ]Psychiatrie, LWL-Universitaetsklinikum der Ruhr-Universitaet Bochum, Bochum, 44791, Germany
                [5 ]Department of Experimental Medicine, University de L'Aquila, Coppito II, L'Aquila, 67100, Italy
                [6 ]Hospital Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Passeig Sant Joan de Déu 2, Esplugues de Llobregat, Barcelona, 08950, Spain
                [7 ]Department of Medical and Scientific Affairs, Janssen EMEA, Johnson & Johnson Platz 1, Neuss, 41470, Germany
                Author notes
                on behalf of the Europe, Middle East and Africa functioning group
                Article
                Publisher ID: 1744-859X-12-8
                DOI: 10.1186/1744-859X-12-8
                PMC ID: 3778848
                PubMed ID: 23531356
                SO-VID: f24a2aec-fd2d-436d-bdee-0bf9b0bda8a9
                Copyright © Copyright ©2013 Gorwood et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 January 2013
                Date accepted : 27 February 2013
                Categories
                Subject: Primary Research

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: assessment,functioning,management,psychiatrist,schizophrenia,survey
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: assessment, functioning, management, psychiatrist, schizophrenia, survey

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