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A significant improvement in the Positive and Negative Syndrome Scale (PANSS) scores as well as in patients' metabolic profile has been observed by switching from conventional antipsychotics, olanzapine, or risperidone to ziprasidone over a 6-week clinical study Switching to improve efficacy and/or tolerability has been studied in several clinical trials. Poor treatment adherence and high discontinuation rates often lead to frequent treatment changes, as it is generally accepted that subjects who are not responding to an agent belonging to a particular class of psychotropic drugs or who experience adverse events may show a better response to another agent of the same or other therapeutic class Partial or no adherence to treatment has been associated with increased risk of relapse, psychiatric hospitalization, attempted suicide, and clinical and functional deterioration It has been shown that almost half of the patients with schizophrenia or schizoaffective disorder on antipsychotic medication take less than 70% of the prescribed doses Schizophrenic patients under antipsychotic treatment have been shown to exhibit poor adherence and high rates of treatment discontinuation, often within the first year of treatment commencement Maintenance therapy and adherence to treatment are crucial factors for the long-term clinical management of schizophrenia and are key determinants for good prognosis Treating schizophrenia is usually a lifelong process that poses an enormous disease burden on the patient and the caregiver and a great challenge for the physician. Schizophrenia is a chronic, severely disabling psychiatric illness with a lifetime risk ranging from 0.2% to 0.7% and an incidence of 15.2 per 100,000 per year In the ETOS study, switch of antipsychotic monotherapy for reasons relating to lack of efficacy and/or tolerability was associated with significantly improved clinical benefit and significant increase of patients' adherence to treatment.
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By the end of the study, total Positive and Negative Syndrome Scale, Clinical Global Impression-Improvement, Clinical Global Impression-Severity, and Simpson-Angus Scale scores demonstrated significant mean decreases of 31.69, 0.70, 1.14, and 11.30, respectively (all p < 0.0001). Following treatment switch, 87.9% of patients ( n = 499) showed meaningful clinical benefit by achieving a Clinical Global Impression-Clinical Benefit score of ≤4 at the final visit. The main reason for switching antipsychotic treatment was lack of tolerability ( n = 369, 65.0%), followed by lack of efficacy ( n = 249, 43.8%). The final analysis included 568 patients, 39.0 ± 11.2 years old with mean disease duration of 11.7 years. Ethical approval was obtained prior to study initiation (NCT00999895). A total of 574 patients were recruited by 87 hospital- and office-based physicians.
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MethodsĮTOS was an observational 18-week (four visits) study in outpatients 18 to 65 years old, diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders - 4th edition criteria at least 6 months prior to enrolment, who were initiated on a new antipsychotic monotherapy treatment within the 2 weeks prior to enrollment. The ETOS study aimed to identify the reasons leading physicians to decide to switch antipsychotic treatment in outpatients with schizophrenia and to evaluate the outcome of this switch. Patients under antipsychotic treatment for schizophrenia commonly exhibit poor adherence to treatment, high rates of treatment discontinuation, and frequent treatment changes.