Clinical and Social Characteristics, Quality of Life, Adherence to Therapy of Out-Patients with Schizophrenic Spectrum Disorders: Cross-Sectional Study

Background: clinical diversity of schizophrenic spectrum disorders determines a variety of long-term management and treatment outcomes of out-patients.

Aim of the study: to analyze the interrelationships of clinical and social characteristics, quality of life and adherence to therapy in patients with schizophrenic spectrum disorders.

Patients and methods: data of 120 patients observed in a neuropsychiatric dispensary with diagnoses of schizophrenic spectrum disorders (F20, F21, F25 according to ICD-10) were studied.

Results: three categories of individuals were identified, taking into account the high degree of intragroup similarity of clinical and social characteristics. Patients of the first group (29%) have a stable-positive characteristics of social adaptation and a high adherence to therapy. They were characterized by a younger age, mainly an attack-like course of the disease with an affective-delusional structure of exacerbations and weakly pronounced personality changes. Significantly more often than patients of other groups, they received therapy with second-generation antipsychotic drugs of prolonged action. Patients of the second group (39%) have the negative dynamic characteristics of social adaptation and a low adherence to therapy. They were characterized by older age, continuous or episodic types of disease course with increasing defect, higher prevalence of moderately and strongly pronounced positive and negative symptoms at the time of remission. Treatment and rehabilitation measures did not give sufficient results, despite the active use of prolonged antipsychotic drugs of the second generation. In this category of patients, there were phenomena of social drift, with the collapse of social ties, loss of work skills. Patients of the third group (32%) were characterized by contradictory characteristics with stable negative characteristics of social adaptation and high adherence to therapy. A significant part of the patients had negative personality changes and often a low-grade course of the disease with a predominance of neurosis-like and depressive symptoms. Receiving for many years mainly therapy with firstgeneration antipsychotics (APP1) and practically not hospitalized in a psychiatric hospital, they found pronounced social isolation, loneliness and feelings of hostility of the surrounding world.

Conclusions: the management of out-patients with schizophrenic spectrum disorders represent clinical problems depending of different forms of social adaptation and adherence to therapy, for the effective solution of which it is necessary to optimize complex social rehabilitation measures.

1. Berezantsev AYu, Kostyuk GP, Burygina LA, Levin ME, Masyakin AV. Novyy etap razvitiya sistemy lecheniya i reabilitatsii patsiyentov s rasstroystvami shizofrenicheskogo spektra. Zdravookhraneniye Rossiyskoy Federatsii. 2020;4:181–189. (In Russ.). doi: 10.46563/0044-197x-2020-64-4-181-189

2. Kostyuk GP, Shmukler AB. Golubev SA and Study Group. Epidemiological aspects of diagnosis of schizophrenia in Moscow. Social and Clinical Psychiatry. 2017;27(3):5–9. (In Russ.). elibrary.ru/item. asp?id=300254773.Culbreth AJ, Barch DM, Moran EK. An ecological examination of loneliness and social functioning in people with schizophrenia. J Abnorm Psychol. 2021;130(8):899–908. doi: 10.1037/abn0000706

3. Lehman AF, Postrado LT, Rachuba LT. Convergent validation of quality of life assessments for the persons with severe mental illnesses. Quality Life Research. 1993;2(5):327–333. doi: 10.1007/BF00449427

4. Simpson CJ, Hyde CE, Faragher EB. The chronically mentally ill in community facilities: A study of quality of life. Br J Psych. 1989;154:77–82. doi: 10.1192/bjp.154.1.77

5. Berezantsev AYu, Burygina LA, Levin ME. Some current trends in the use of prolonged injectable anti-psychotics in the conditions of modernization of the psychiatric service. S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2020;120(6–2):61–67. (In Russ.). doi: 10.17116/jnevro202012006261

6. Bloch Y, Mendlovic S, Strupinsky S, Altshuler A, Fennig S, Ratzoni G. Injections of depot antipsychotic medications in patients suffering from schizophrenia: do they hurt? J Clin. Psychiat. 2001;62(11):855– 859. doi: 10.4088/jcp.v62n1104

7. Marder SR. Overview of partial compliance. J Clin Psychiat. 2003;64(16):3–9. PMID: 14680412.

8. Math SB, Chandrashekar CR, Bhugra D. Psychiatric epidemiology in India. Indian J Med Res. 2007;126(3):183–192. PMID: 18037711.

9. Lyubov EB. The social and economic burden of schizophrenia. Social and Clinical Psychiatry. 2012;22(2):100–108. (In Russ.). elibrary.ru/item.asp?id=17874168

10. Weiden PJ, Kozma C, Grogg A, Locklear J. Partial compliance and risk of rehospitalization among California Medicaid patients with schizophrenia. Psychiatr Serv. 2004;55(8):886–891. doi: 10.1176/appi.ps.55.8.886

11. Mosolov SN. Some actual theoretical problems of diagnosis, classification, neurobiology and therapy of schizophrenia: comparison of foreign and domestic approaches. Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova. 2010;110(6):4–11. (In Russ.). elibrary.ru/NQZNTN

12. Kuzmenko AYu, Zaitseva MS, Kostyuk GP, Khannanova AN, Kurmyshev MV. Efficacy of long-acting antipsychotics in treatment of schizophrenics with frequent admissions. Social and Clinical Psychiatry. 2016;26(4):51–56. (In Russ.). elibrary.ru/item.asp?id=27511283

13. Kirson NY, Weiden PJ, Yermakov S, Huang W, Samuelson T, Offord SJ, Greenberg PE, Wong BJ. Efficacy and effectiveness of depot versus oral antipsychotics in schizophrenia: synthesizing results across different research designs. J Clin Psychiatry. 2013;74(6):568– 575. doi: 10.4088/JCP.12r08167

14. Leucht C, Heres S, Kane JM, Kissling W, Davis JM, Leucht S. Oral versus depot antipsychotic drugs for schizophrenia — a critical systematic review and meta-analysis of randomised long-term trials. Schizophr Res. 2011;127(1–3):83–92. doi: 10.1016/j.schres.2010.11.020

15. Eerdekens M, Van Hove I, Remmerie B, Mannaert E. Pharmacokinetics and tolerability of long-acting risperidone in schizophrenia. Schizophr Res. 2004;70(1):91–100. doi: 0.1016/j.schres.2003.11.001

16. Edwards NC, Locklear JC, Rupnow MF, Diamond RJ. Cost effectiveness of long-acting risperidone injection versus alternative antipsychotic agents in patients with schizophrenia in the USA. Pharmacoeconomics. 2005;23(1):75–89. doi: 10.2165/00019053-200523001-00007

17. Gowda GS, Isaac MK. Models of Care of Schizophrenia in the Community-An International Perspective. Curr Psychiatry Rep. 2022;24(3):195–202. doi: 10.1007/s11920-022-01329-0

18. Bighelli I, Rodolico A, García-Mieres H, Pitschel-Walz G, Hansen WP, Schneider-Thoma J, Siafs S, Wu H, Wang D, Salanti G, Furukawa TA, Barbui C, Leucht S. Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry. 2021;8(11):969–980. doi: 10.1016/S2215-0366(21)00243-1

19. Sood M, Chadda RK, Chawla N, Sharma MR, Patel R, Mohan M, Iyer S, Padmavati R, Thara R, Singh SP. Understanding needs of stakeholders and outcomes desired from a home-based intervention program for “difficult to treat” schizophrenia and related disorders: A qualitative study. Indian J Psychiatry. 2022;64(1):38–47. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_252_21

20. Sorokin MY, Neznanov NG, Lutova NB, Wied VD. Revisiting Drug Compliance: The Need for a Holistic Approach in the Treatment of Severe Mental Disorders. Consortium Psychiatricum. 2021;2(3):17–25. doi: 10.17816/CP93