Worldwide Schizophrenia Characteristics, Outcomes 'Strikingly' Similar
By Caroline Cassels
Medscape Medical News
November 19, 2009 — An international study of more than 17,000 individuals with schizophrenia from 37 countries reveals striking similarities in symptoms, medication, employment, and sexual problems.
The 3-year, observational study included 17,384 patients who were all starting to use or changing their antipsychotic medication. The results showed that participants had an average age of 38 years, and 57% were male. The median duration of illness was 7 years, and 1 in 10 was receiving antipsychotic medications for the first time.
On average, only 19% were in paid employment, 69% were living in dependent housing, and 62% reported experiencing sexual problems in the previous month.
"Although there were some regional and country variations, on the whole the study provided a strikingly similar overall pattern when it came to key health, medication, and socioeconomic factors," lead investigator Jamie Karagianis, MD, Eli Lilly Canada Inc, Toronto, Ontario, said in a statement.
"It has enabled us to build up a valuable international picture of the demographics and treatment of schizophrenia across 10 European countries and 27 countries from East Asia, Latin America, North Africa, and the Middle East," he added.
The study is published in the November issue of the International Journal of Clinical Practice and was sponsored by Eli Lilly Canada Inc.
Ongoing Debate
According to the paper, most randomized controlled trial data for schizophrenia are based on North American patients, which account for only 2% of the global schizophrenia population.
In addition, Dr. Karagianis pointed out that there has been an ongoing debate over whether developed and developing countries display different outcomes and noted that 21 of the 37 countries included in the study are emerging or developing countries.
The aim of the survey was to assess costs and outcomes of antipsychotic use in outpatients initiating use of or changing antipsychotics with an emphasis on olanzapine compared with other antipsychotic medications.
The study's main outcome measures included Clinical Global Impression–Schizophrenia (CGI-SCH) severity scores, psychotropic medication use, adverse events, social interaction, housing and employment status, self-perceived health state, and reasons for initiating use of or changing antipsychotic medications.
Patients were assessed at baseline and at 3, 6, 18, 24, and 36 months. All clinicians taking part in the study were free to determine the type of treatment their patients received, and no drugs were provided by the study sponsor.
Key Findings
The study showed:
25.7% of study participants were taking more than 1 antipsychotic and 73.6% were receiving concomitant prescription medications, including anticholinergics, antidepressants, anxiolytics or hypnotics, or mood stabilizers;
10% were taking antipsychotics for the first time;
Key reasons for changing medication were the same across all the regions surveyed, with two-thirds of the investigators citing lack of effectiveness, followed by intolerance, patient request, and incomplete adherence to the medication;
Just more than 34% of patients had been admitted to an inpatient facility because of their schizophrenia in the last 6 months. With the exception of the Latin American region (40.8%), all the other regions showed similar rates, ranging from 31.2% to 36.3%;
61.5% of participants reported sexual dysfunction, with the exception of East Asia (33.5%); the other regions reported similar levels, ranging from 57.9% to 67%;
The CGI-SCH scores were remarkably similar, with an overall average of 4.4 and regional scores ranging from 3.9 to 4.7. The positive score averaged 3.9; the negative score, 4.0; depressive score, 3.4; and cognitive score, 3.7;
25.8% of the patients had ever attempted suicide, with regional scores ranging from 21.7% to 30.1%;
Paid employment status was similar, averaging 19% and ranging from 16.2% to 22.6%; and
32.1% of participants were in a relationship, ranging from 25.1% to 38.6% in 5 of the 6 regions. People in East Asia were much more likely to be in a relationship than anywhere else (47.4%).
Study authors Karagianis, Novick, Dossenbach, Treuer, Montegomery, Walton, and Lowry are employees of Eli Lilly. Dr. Dossenbach and Dr. Karagianis are stock shareholders in Eli Lilly. Dr. Haro reports receiving compensation for participation in the European Union Schizophrenia Outpatient Health Outcomes Advisory Board. Dr. Pecenak is a member of the speaker's/advisory boards for Eli Lilly, Astra Zeneca, Servier, and Janssen Cilag.