Persons suffering from schizophrenia and relapses

• Published in: Encéphale Vol. 35; no. 6; p. 586
• Main Authors: Passerieux, C, Caroli, F, Giraud-Baro, E
• Format: Journal Article
• Language: French
• Published: France 01.12.2009
• Subjects: Administration, Oral; Adult; Aged; Antipsychotic Agents - therapeutic use; Caregivers - psychology; Caregivers - statistics & numerical data; Female; France; Health Surveys; Hospitalization - statistics & numerical data; Humans; Injections, Intramuscular; Male; Medication Adherence - statistics & numerical data; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Recurrence; Schizophrenia - diagnosis; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Schizophrenic Psychology; Surveys and Questionnaires; France
• ISSN: 0013-7006
• DOI: 10.1016/j.encep.2009.10.005

In schizophrenia, relapse is a common event that affects more than half the patients within 2 years after a first episode. It is a real setback for them and their relatives. Surprisingly, we do not have much information on how patients and their relatives experience the relapse. A national survey was conducted among 316 schizophrenic outpatients treated with antipsychotics, and 82 of their relatives. The survey assessed the following four aspects: disease history, last relapse history, hospitalization experiences, and relapse prevention. Regarding the disease history, the average psychiatric follow-up was 13 years and patients had been hospitalized five times on average. Relatives reported approximately the same history. Regarding the last relapse, 9/10 of relatives reported that this relapse led to hospitalization and 69% of patients understood that their hospitalizations were due to relapse. 4% of patients and 7% of relatives identified the end of the treatment as a precursor to relapse. While a lack of compliance was found in about four relapses out of 10. It has also been shown that patients confided primarily in the medical team and the relatives thought to be the first confidant of patients. Regarding the experience of hospitalization, 87% of patients and 86% of relatives judged the hospitalization useful. For both, hospitalization represented a solving step to manifestations of relapse. Regarding the relapse prevention, almost three patients out of four thought they knew what to do in order to avoid a new relapse, while only 52% of the relatives thought patients knew what to do for this matter. For more than one third of the patients, the last relapse (3 years ago) was still a painful event. Avoiding a new relapse was considered very important or important by 91% of patients and 100% of relatives. Relatives felt that regular appointments with the medical team helped avoid relapses. Fifty-nine per cent of relatives have said it was difficult to verify whether or not the treatment was taken by a schizophrenic patient. Relatives' opinion on the injectable treatment was favorable and approximately 50% of the patients declared knowing of injectable treatments. Among these 72% felt that such treatment was reassuring, 69% said it was simpler than oral therapy, and 67% thought it was the most suitable to check the compliance. Only 31% considered it restricting for the patient, against 54% who were considering it not restricting. Finally 57% of patients were willing to take an injectable treatment in order to prevent further hospitalization. This study brings us a better understanding of patients' and relatives' experience of relapse. These results demonstrate the potential impact of relapse on the patients and their relatives and highlight their motivation to avoid further relapses. Also revealed, the lack of importance given to the link between compliance and relapse by patients and relatives. These results underscore the complexity of this disease management in which each player has a key role.