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Value of schizophrenia treatment I: The patient journey

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Pavel Mohr, Silvana Galderisi, Patrice Boyer, Danuta Wasserman, Paul Arteel, Aagje Ieven, Hilkka Karkkainen, Eulalia Pereira, Nick Guldemond, Petr Winkler, Wolfgang Gaebel

Original languageEnglish
Pages (from-to)107-115
Number of pages9
JournalEuropean Psychiatry
Volume53
Early online date20 Jul 2018
DOIs
Accepted/In press25 Jun 2018
E-pub ahead of print20 Jul 2018
Published2018

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Abstract

Background
The aim of the European Brain Council project “The Value of Treatment” was to provide evidence-based, cost-effective policy recommendations for a patient-centered and sustainable coordinated care model for brain disorders. The first part of schizophrenia study examined the needs and gaps in the patients' care pathway.

Methods
Descriptive analysis was based on an inventory of needs and treatment opportunities, using focus group sessions, expert interviews, users’ input, and literature review. Three patient pathways were selected: indicated prevention, duration of untreated psychosis, and relapse prevention.

Results
The analysis identified several critical barriers to optimal treatment. Available health care services often miss or delay detection of symptoms and diagnosis in at-risk individuals. There is a lack of illness awareness among patients, families, and the public; scarcity of information, training and education among primary care providers; stigmatizing beliefs. Early symptom recognition and timely intervention result in better outcome and prognosis; effective management leads to a functional recovery. In the current model of care, there is insufficient cooperation between health and social care providers, patients and families, inadequate utilization of pharmacological and psychosocial interventions, lacking patient monitoring, and low implementation of integrated community care.

Conclusions
Early detection and early intervention programs, timely intervention, and relapse prevention are essential for effective management of schizophrenia. It requires a paradigm shift from symptom control, achieving and maintaining remission, to the emphasis on recovery. Since the current services are not able to accomplish this goal, changes in mental health policies are needed.

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