[Clinical guidelines for the management of schizophrenia (ΙΙ): Community service-level interventions and the role of Primary Care]

Abstract

Schizophrenia is one of the most disabling disorders globally, with a significant impact on the professional, social and personal functioning of those affected. Mortality rates are estimated to be 2-2.5 times greater than in the general population attributable to not only suicide but also physical illnesses, such as cardiovascular, metabolic and infectious diseases. Patients with schizophrenia have increased needs for health services which vary according to the stage of the illness and the way the disorder affects the patient. A significant part of the costs of treating patients with schizophrenia is attributed to the health service costs, both to address the disorder itself and its wider effects. In 2015 the National Clinical Guidelines for the management of schizophrenia were formulated by a Working Group that was set up by the Greek Ministry of Health. In this article, a summary of the recommendations (as included in the National Clinical Guidelines) is presented, describing the role of primary care and community mental health services in the management of schizophrenia. The NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia was utilized as the main guide to develop the Greek National Guidelines . In addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA, 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists, 2005), as well as other relevant sources were also used. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. Special effort was made to adapt the international experience to the current Greek landscape with its constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. The proposals aim to contribute to the efficient implementation of the provision of community mental health services for patients suffering from psychotic disorders, focusing in particular on: (a) the role of primary health care services and the role of family physician in the treatment of schizophrenia; (b) the cooperation and coordination between mental health services and primary care services in order to ensure continuity of care (c) designing services that deliver evidence-based interventions,thus ensuring that a larger proportion of the population receives interventions with documented effectiveness in the treatment of schizophrenia, in the least restrictive environment. A particular emphasis is placed on services that are expected to reduce the need for hospitalization, such as crisis intervention services, community interventions aimed at maintaining and continuing the treatment of difficult patients who tend to be lost to follow up from services and early intervention services in psychosis.