Using Relapse Prevention Interventions to Maintain Remission and Minimize Relapse Rates for Individuals With Schizophrenia: A Scoping Review

The Impact of Using Digital Health Interventions and Psychoeducation on Medication Adherence Among Patients with Schizophrenia: A Scoping Review

BACKGROUND

Schizophrenia is a significant global mental health concern. It is associated with substantial disability and psychosis and can have an impact on all aspects of life. Medication is an appropriate and effective treatment; thus, improving adherence remains a main concern among patients with schizophrenia in clinical practice. Several approaches, such as digital health interventions (DHI) and psychoeducational approaches, may enhance medication adherence. Despite several efforts to create and improve these approaches, their impact remains unclear.

OBJECTIVE

Conduct a scoping review to provide an overview of how digital health interventions and psychoeducation impact the medication adherence of individuals with schizophrenia.

METHOD

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we screened 435 studies published between 2019 and 2024 from the databases including Springer Link, MEDLINE, Pro-Quest Central, CINAHL Plus, and Google Scholar. All articles were filtered using inclusion criteria to eliminate redundant, irrelevant, and unnecessary content.

RESULTS

A total of 14 articles that addressed DHI and psychoeducational interventions for medication adherence in patients with schizophrenia were found to meet the inclusion criteria. Four themes emerged: psychoeducation, mobile applications, telephone interventions, and digital medical systems. DHI and psychoeducation effectively improved medication adherence, with mobile applications being the most popular and successful.

CONCLUSION

The findings of this review should be used by healthcare professionals to direct their clinical practice. Interventions in digital health can provide a wealth of creative ideas for integrating technical advancement with psychotherapies.

Novel pharmaceutical treatment approaches for schizophrenia: a systematic literature review

PURPOSE

Schizophrenia is a chronic and debilitating neuropsychiatric disorder affecting approximately 1% of the global population. Traditional antipsychotic treatments, while effective for positive symptoms, often have significant side effects and fail to address cognitive and negative symptoms. Novel pharmacological treatments targeting muscarinic receptors, TAAR1 agonists, serotonergic pathways, and glutamate modulation have emerged as promising alternatives.

AIM

This systematic literature review aims to critically evaluate the efficacy, safety, and mechanisms of action of novel pharmacological agents in the treatment of schizophrenia.

METHODS

A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science for randomized controlled trials (RCTs) and clinical trials published between April 2014 and March 2024. Studies evaluating novel treatments targeting muscarinic receptors, TAAR1 agonists, serotonergic agents, and glutamate modulation were included. Primary outcomes focused on symptom reduction and quality of life, while secondary outcomes included cognitive function and adverse events. The Joanna Briggs Institute (JBI) tool was used for quality assessment.

RESULTS

Eleven studies involving 4614 participants (mean age 37-43 years, predominantly male) were included. Drugs evaluated included xanomeline-trospium (KarXT), pimavanserin, ulotaront, emraclidine, and bitopertin. Significant improvements in PANSS and CGI-S scores were observed, with xanomeline-trospium showing a mean reduction of 17.4 points (p < 0.001). Adverse events were mostly mild and transient, with nausea, constipation, and somnolence being common.

CONCLUSION

Novel treatments for schizophrenia show promise in managing both positive and negative symptoms, with generally favorable safety profiles. Future studies should focus on large-scale, long-term trials to refine their efficacy, safety, and clinical applicability.

Inflammatory blood cells and ratios at remission for psychosis relapse prediction: A three-year follow-up of a cohort of first episodes of schizophrenia

BACKGROUND

The clinical course following a first episode of schizophrenia (FES) is often characterized by recurrent relapses, resulting in unfavorable clinical and functional outcomes. Inflammatory dysregulation has been implicated in relapse risk; however, the predictive value of inflammatory blood cells in clinically remitted patients after a FES has not been previously explored.

METHODS

In this study, we closely monitored 111 patients in remission after a FES until relapse or a three-year follow-up endpoint. The participants were recruited from the multicenter 2EPS Project. Data on inflammatory blood cells and ratios were collected at baseline and at the time of relapse or after three years of follow-up.

RESULTS

Monocyte counts (OR = 1.91; 95 % CI = 1.07-3.18; p = 0.009) and basophil counts (OR = 1.09; 95 % CI = 1.01-1.12; p = 0.005) at baseline were associated with an increased risk of relapse, while the platelet-lymphocyte ratio (OR = 0.98; 95 % CI = 0.97-0.99; p = 0.019) was identified as a protective factor. However, after adjusting for cannabis and tobacco use during the follow-up, only monocyte counts (OR = 1.73; 95 % CI = 1.03-2.29; p = 0.027) and basophil counts (OR = 1.08; 95 % CI = 1.01-1.14; p = 0.008) remained statistically significant. ROC curve analysis indicated that the optimal cut-off values for discriminating relapsers were 0.52 × 10^9/L (AUC: 0.66) for monocytes and 0.025 × 10^9/L (AUC: 0.75) for basophils. When considering baseline inflammatory levels, no significant differences were observed in the inflammatory biomarkers at the endpoint between relapsers and non-relapsers.

CONCLUSION

This study provides evidence that higher monocyte and basophil counts measured at remission after a FES are associated with an increased risk of relapse during a three-year follow-up period.

The Assessment of Awareness of Early Warning Signs of Bipolar Disorder Recurrence Among Patients and Their Main Caregivers in Jordan

Introduction

One of the biggest challenges to public health is increasing knowledge of the early warning signs (EWS) of bipolar disorder recurrence. The recurrence incidence is still high despite multiple attempts to improve the awareness level. The awareness level is still ambiguous and insufficient.

Objective

The purpose of this study was to assess the degree of awareness of EWS of bipolar disorder recurrence among patients and their main caregivers in Jordan.

Methods

A descriptive cross-sectional design was used to recruit 275 patients and their main caregivers to fill out the adapted version of the Awareness of the EWS of Relapse Questionnaire.

Results

The analysis showed that patients and their main caregivers' awareness of the EWS of bipolar disorder recurrence was low and inadequate (patients, mean = 2.61 (SD = 2.6); main caregivers, mean = 3.84 (SD = 2.2); scores range from 0 to 10).

Conclusion

According to the study, the awareness level of these signs is still vague and inadequate. This means that ensuring long-term positive results for patients and their main caregivers requires a high degree of awareness regarding the warning signs and symptoms of bipolar disorder recurrence. To engage in standard practice, EWS of bipolar disorder recurrence awareness necessitate adequate resources, support, and an empowered and well-communicated multidisciplinary team.