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Treatment adherence in schizophrenia. Spanish clinical consensus.

Objective. Establish a Spanish Consensus on Therapeutic Compliance in Schizophrenia. Material and methods. An experts committee designed a specific questionnaire having 40 questions and 293 options. The questions referred to the definition and general assessment of compliance in schizophrenia, factors involved, intervention strategies in outpatients and in acute units and management of oral and long duration injectable antipsychotic drugs and other non-pharmacological therapies. First, second or third line strategy values of choice were assigned according to the answers obtained for each item. The questionnaire was sent to 383 psychiatrists of a Therapeutic Compliance Work Group. A total of 326 answers were received with an electronic system that guaranteed their confidentiality. Results and conclusions. There is maximum agreement on considering the seriousness of the compliance problem, its repercussion in relapses, the patient's course and increase in health care costs. The strategies preferred to evaluate compliance are: counting of the injectable drug administration and determination of plasma concentrations. The Consensus considers that specific intervention is necessary when the patient has already suffered several relapses due to low therapeutic compliance, when null awareness of disease is detected or if there is comorbidity with toxic consumption. Psychoeducational is the non-pharmacological strategy having the greatest consensus grade if intervention is needed. Treatments with atypical injectable, long duration, antipsychotic drugs obtain the best grade in accordance with pharmacological strategies of first choice, in different clinical situations to avoid or improve therapeutic adherence. Key words: Adherence. Compliance. Schizophrenia. Consensus.

Antipsychotic Agents↗

PubMedDate not supplied

[Clinical characteristics and epidemiologic study of a listeriosis outbreak in Grand Canary].

BACKGROUND AND METHODS: Human infections caused by Listeria monocytogenes often present as sporadic cases without any epidemiological relationship among them; however they also appear as outbreaks that are usually detected by an increase in the number of cases diagnosed by hospitals of the geographic area. Between December 1991 and May 1993, twenty four cases of listeriosis were detected in three hospitals of Las Palmas de Gran Canaria; and they were classified as an outbreak. Our report describes its clinical, epidemiological and microbiological aspects. RESULTS AND CONCLUSIONS: Twenty four cases of listeriosis were diagnosed, 12 occurred in pregnant women or neonates (5 and 7 respectively) and 12 in non pregnant adults. All adult infections were community-acquired. The incidence rate was, for the epidemic area, 76.3 cases per million population during the period considered (18 months). Among non pregnant adults, 9/12 patients had some underlying disease and 9/12 presented CNS affection (meningitis and/or cerebritis). In the group of pregnant women, 4 cases occurred in the second trimester and fetal loss was caused; one case was detected in the third trimester and four weeks later the patient delivered an unaffected infant. All cases of neonatal listeriosis presented as early-onset sepsis. Of the 24 strains of L. monocytogenes, 21 were serotype 4, two were serotype 1 and one was not typeable. Strains from 12 patients were available for epidemiological analysis, seven of which corresponded to the same pattern and there were three more different patterns.

Abortion, Spontaneous↗