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consequences of relapse in schizophrenia

consequences of relapse in schizophrenia

So this is the flaw, in not having definitive evidence. Only in psychiatry would you have a situation over half a century from the discovery of a major advance in therapeutics and with a countless number of studies demonstrating acute and prophylactic efficacy of a class of medications, would you still have people questioning the effectiveness of these medicines, either overtly or subtly encouraging people to avoid the use of antipsychotic medications. John M. Kane, MD: Absolutely. Overcoming Obstacles to LAIs in Schizophrenia Management, 16. Keywords: People who have psychotic relapses can sometimes be involved in the criminal justice system. Experts in the management of patients with schizophrenia highlight typical predictors of relapse and stress the importance of counseling patients on what to monitor for. Relapse in schizophrenia remains common and cannot be entirely eliminated even by the best combination of biological and psychosocial interventions (Reference Linszen, Lenior and de Haan Linszen et al, 1998).Relapse prevention is crucial as each relapse may result in the growth of residual symptoms (Reference Shepherd, Watt and Falloon Shepherd et al, 1989) and accelerating social … Effects of Schizophrenia Relapse on Hospitalization, 11. Methods: The Europe, the Middle East, and Africa (EMEA) Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was conducted by questionnaire during January-March 2010 among psychiatrists treating patients with schizophrenia in 36 countries. In view of the severe consequences of this disease for each individual patient and his family, but also in view of the immense costs incurred by each relapse, we must not rest content with this situation. Schizophrenia: Consequences of Multiple Relapses, 21. Relapse in schizophrenia remains common and cannot be entirely eliminated even by the best combination of biological and psychosocial inter-ventions (Linszen et al, 1998). Expert panelists review the causes, diagnostic work-up, management, and emerging therapies inherent in the evolving paradigm of irritable bowel syndrome. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. That means that the symptoms come back. The consequences of relapse are multiple, psychological, biological and social. Being psychotic is bad for your brain too. Consequences of Relapses in Schizophrenia, 12. Relapse, even the first one, will contribute to worsen the outcome of the disease and reduce the capacity in general functionning. So this is a characteristic of schizophrenia. [Drawing up guidelines for the attendance of physical health of patients with severe mental illness]. The prevailing model is that schizophrenia is a neurodevelopmental disorder with no precise boundary, or single cause, and is thought to develop from gene–environment interactions with involved vulnerability factors. 2009 Sep;35(4):330-9. doi: 10.1016/j.encep.2008.10.014. Results: Even in shortterm trials, medication adherence in patients with schizophrenia comes up to merely 50%. And you referenced the potential changes in brain physiology or brain function. One is the disruption it might have on your job or your housing, or to your relationships. Relapse prevention is crucial as each relapse may result in the growth of residual symptoms (Shepherd et al, 1989) and accelerating social disablement (Hogarty et al, 1991). Like any health problem, in schizophrenia relapses often tend to strike when you are least expecting them. T. Scott Stroup, MD, MPH: I strongly agree that we need to be carefully monitoring for adverse effects of antipsychotic medications and managing them. But you know, I really try to use more of the motivational interviewing kind of approach to say, “You know, there are things you want to do, like work or have relationships or maintain housing, and medications may be one way to help you maintain those things.” NIH John M. Kane, MD: One of the challenges we have is that not all of our patients have good insight into their illness, and sometimes, when people feel better, they don’t necessarily see the need for medication. T. Scott Stroup, MD, MPH: Right. It is based on adherence to the maintenance treatment, identification of prodromes, family active information and patient therapeutical education. And unfortunately, or fortunately, when people stop their medications they don’t always see the effect of that right away. They took the medicine and, “I’m better. The causes of schizophrenia are not properly identified. A relapse can happen when you have schizophrenia. 2013 May;39 Suppl 1:S8-14. Schizophrenia is a chronic, disabling illness in which most patients experience frequent periods of psychotic exacerbation and relapse (Csernansky et al., 2002).Relapse in schizophrenia can be associated with progressive functional deterioration, declining treatment response, worsening clinical outcome, escalating caregiver burden, and an increased economic burden for … I think that it’s a double standard, it’s wrong-minded, and it’s destructive. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Jeffrey A. Lieberman, MD: I characterize it this way. Underutilization of LAI Antipsychotics in Schizophrenia, 9. [Rationale for the use of long-acting injectable risperidone: a survey of French psychiatrists]. Schizophrenia is a chronic, disabling illness in which most patients experience frequent periods of psychotic exacerbation and relapse (Csernansky et al., 2002). eCollection 2017. For It seems to be tied to the process of having psychotic episodes, and then with the advent of imaging, it was associated with the possibility that the progression is reflected by some structural brain changes in the form of a reduction of volume of certain regions in the brain, and particularly in the gray matter. But relapses can happen. So in essence, although there are these different ways of construing the evidence, it seems to me that to not use medication for fear of long-term effects is completely wrong and that the long-term benefits clearly outweigh the potential risks. Recent studies claim for the advantages of atypical over first generation antipsychotic medication. 2009 Feb;35(1):80-9. doi: 10.1016/j.encep.2007.12.009. And so, they need to understand the concept of prevention or prophylaxis, and they also need to understand the consequences of relapse. LAI Antipsychotics in Schizophrenia: Clinician's Role, 5. The consequences of relapse are multiple, psychological, biological and social. Therefore, the … 2017 Aug 22;17(1):299. doi: 10.1186/s12888-017-1425-9. Relapses and re-hospitalization are frequent in patients with schizophrenia and bipolar disorder [4, 5]. Optimal Treatment of Schizophrenia: Take-Home Messages, 15. Due to its variable aspects, there is no operational definition of relapse able to modelise the outcome of schizophrenia and measure how the treatment modifies the disease. John M. Kane, MD: And sometimes it’s hard for them to really see that. [Stabilisation of post-acute stage schizophrenics: from the hospital to the city]. Tags: consequences,mental health,peer exchange,relapse,Retail,schizophrenia, Copyright Specialty Pharmacy Times 2006-2019, 2 Clarke Drive Suite 100 Cranbury, NJ 08512 P:609-716-7777 F:609-716-9038, 1. The literature investigating the consequences of withholding treatment and the consequences of relapse in schizophrenia is inadequate.7 There are few well designed longitudinal studies assessing the psychosocial and biological consequences of exposure to placebos or relapse. Epub 2014 Sep 17. Predictors of Relapse in Schizophrenia, 13. Adherence to Oral Agents in Schizophrenia Management, 19. T. Scott Stroup, MD, MPH: People have an acute illness model. Improving Resistance to Use LAI Therapy in Schizophrenia, 4. The problem with those studies though was that these animal studies were normal monkeys. This means you can't tell the difference between what is real and what isn't real. Despite the fact that studies varied in relapse definitions and duration of follow-up, the risk of relapse is still high. Now, the countervailing line of evidence that individuals will site as cautionary, is the studies that suggest that people who get more antipsychotic medication may lose more volume in brain gray matter. They may be arrested for something or … June 12, 2013. The effectiveness of antipsychotic medications on relapse prevention has been widely demonstrated. T. Scott Stroup, MD, MPH: I think there are 2 kinds of consequences. LAI Antipsychotics in Schizophrenia: Tolerability, 6. 1 The economic burden of schizophrenia was estimated in 33 billion dollars in the United States in 1990. Epub 2008 May 19. So the specific arguments Scott began to describe are: If you risk discontinuing medicine, even if it’s done in a rational and deliberate way, you will be vulnerable to have symptoms recur.  |  In addition to these negative psycho-social consequences of relapse, there may be an additional risk of biological harm. I think it’s a very challenging part of the therapeutic relationship to try and instill, in a young person who’s experiencing the onset of this illness, the right kind of information and the right kind of motivation without scaring them too much. Saravane D, Feve B, Frances Y, Corruble E, Lancon C, Chanson P, Maison P, Terra JL, Azorin JM; avec le soutien institutionnel du laboratoire Lilly. This concerns the rates of relapse and readmission, morbidity and mortality, - in particular suicide -, as well as the economic burden of society. Unmet Needs and Challenges in Managing Schizophrenia. So it can be a real challenge. Encephale. Published by Elsevier Masson SAS.. All rights reserved. Clipboard, Search History, and several other advanced features are temporarily unavailable. The development of integrated actions on modifiable risk factors such as psychosocial support, addictive comorbidities, access to care and the therapeutic alliance should be promoted. Naturalistic studies have found that the cumulative relapse rate was 70%-82% up to 5 years Keywords: Schizophrenia, Relapse, Antipsychotics, Discontinuation, First-episode, Dopamine Introduction Schizophrenia is a chronic and disabling illness, with the majority of patients experiencing multiple relapses during the course of the illness [1]. They weren’t individuals who had schizophrenia. The negative consequences of medication non-adherence are substantial. Emerging Therapies & Strategies in Schizophrenia, 3. Consequences Of Relapses In Schizophrenia ... schizophrenia relapse what to know even with good management most people with schizophrenia experience relapses over time recognizing and responding to symptoms can help prevent hospitalization Itareps Information Technology Aided Relapse Prevention John M. Kane, MD: Time to response is longer. 2014 Oct;40(5):401-7. doi: 10.1016/j.encep.2014.08.008. There’s this other sort of biological thing—psychosis. A relapse or a psychotic episode can be very intense and scary. Encephale. We critically review selected literature regarding the nature and underlying neurobiology of relapse. Yeisen RAH, Bjornestad J, Joa I, Johannessen JO, Opjordsmoen S. BMC Psychiatry. So relapse is to be avoided by all costs, I think, when we think about the possibility of hospitalization under the current circumstances. Treatment continuation of four long-acting antipsychotic medications in the Netherlands and Belgium: A retrospective database study. Experiences of antipsychotic use in patients with early psychosis: a two-year follow-up study. Schizophrenia is a chronic disorder with serious physical, social and economic consequences. Benefit of Long Acting Injectables in Schizophrenia, 18. doi: 10.1371/journal.pone.0179049. Epub 2013 Mar 28. John M. Kane, MD: And the irony is that when people are lulled into a false sense of security that they’re doing well, they actually have a lot to lose. When schizophrenia is under control, and the symptoms stop or get better, it can be easy to think it’s behind you. den of treating schizophrenia. Aust N Z J Psychiatry. Follow-up studies based on proxys such as hospital admission revealed that 7 of 10 patients relapsed after a first episode of schizophrenia. Signs of a Relapse: Schizophrenia Symptoms toLook For A relapse is when the symptoms of schizophrenia worsen after a person in treatment has been feeling and acting better for a period of time. Importance of Relapse Prevention in Schizophrenia, 22. So if you were to do the unethical, impossible-to-do study where you took first-episode patients and you randomized them to placebo, or you randomized them to treatment, and you took healthy controls and you just followed them, what I predict you would see is a decline in brain volume in specific regions in the untreated illness group, and you would see less of a decline in the treated group. 2 Much of this cost can be attributed to the consequences of psychotic relapse. Relapse, even the first one, will contribute to worsen the outcome of the disease and reduce the capacity in general functionning. Not making the diagnosis of schizophrenia as early as possible may have serious consequences if it leads to a less assertive approach to medication adherence and relapse prevention, and not urgently providing psychoeducation about the need for long-term maintenance antipsychotic therapy as soon as the diagnosis is made. T. Scott Stroup, MD, MPH: I think there are 2 kinds of consequences. Epub 2009 Jul 9. Decuypere F, Sermon J, Geerts P, Denee TR, De Vos C, Malfait B, Lamotte M, Mulder CL. The American Journal of Pharmacy Benefits.  |  Some early warning signs that someone you care for may be headed for a relapse that may result in hospitalization include: There is a lack of well-designed longitudinal studies investigating the psychosocial and biological consequences of exposure to placebo, to treatment discontinuation and to relapse in schizophrenia. Relapse, characterised by acute psychotic exacerbation, may have serious implications. USA.gov. 3 The disorder is usually characterized by relapses alternating with periods of full or partial remission. Schizophrenia, like other mental ... medication as prescribed or discontinuing medication without the direction of a doctor, which can result in serious consequences, such as repeated relapse. Causes and consequences of duration of untreated psychosis in schizophrenia - Volume 177 Issue 6 - Richard J. Drake, Clifford J. Haley, Shahid Akhtar, Shôn W. Lewis While the treatment response when antipsychotics are re-initiated after re-lapse is variable, some patients exhibit protracted impairment of response and, importantly, treatment failure emerges in Misdrahi D, Delgado A, Bouju S, Comet D, Chiariny JF. To estimate the probability of relapse in individuals with schizophrenia receiving treatment with lurasidone or quetiapine XR, a systematic literature review was conducted through PubMed. December 20, 2018. [Therapeutic alliance, a stake in schizophrenia]. One is the disruption it might have on your job or your housing, or to your relationships. LAI Antipsychotics: Establishing a Treatment Plan, 8. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Multiple relapses characterise the course of illness in most patients with schizophrenia, yet the nature of these episodes has not been extensively researched and clinicians may not always be aware of important implications. And that can hit home pretty readily. This site needs JavaScript to work properly.  |  doi: 10.1016/j.encep.2012.03.005. Relapse rates in schizophrenia have been studied extensively in both naturalistic and controlled studies. We’ve also seen some studies recently suggesting that with each relapse the time to response is reduced, and the group at the University of Toronto studied about 130 first-episode schizophrenia patients demonstrating that. And if symptoms recur, there’s immediately some disruption to your life. How would you present that to a patient, in terms of thinking about the consequences of relapse? There’s been a lot of interesting discussion, data, controversies about the effects of medication over the long term and the effects of being psychotic on the brain. There’s also the potential for complications such as suicide, such as violence, such as homelessness. Encephale. Jeffrey, what do you think? ... mental health,predictors of relapse,Retail,schizophrenia. LAI Antipsychotics: Treatment Selection in Schizophrenia, 7. Clinicians review the consequences of relapses on patients with schizophrenia and provide insight on counseling patients on the proper use of antipsychotic therapy. And so there may be disease progression, if that’s the way we think about it. Current Challenges in the Treatment of Schizophrenia, 14. In a relapse, your symptoms return and may be so severe that they cause a psychotic episode. Preparing for Relapses. Pharmaco-clinical studies have demonstrated that the treatment response decreases with each relapse. So how would you characterize them? Schizophrenia: Switching to a Long-Acting Injectable, 17. I’m done.” And trying to draw that link between the medicine; “I’m feeling better because of the medicine.” We think it’s obvious, but it’s not obvious to others. And then there were some studies done in monkeys that compared placebo versus different antipsychotic drugs that showed this atrophy in the brain. Jeffrey A. Lieberman, MD: You mean time to response is longer. In addition, it puts tremendous burden on society in terms of the expenses associated with repeated relapse and hospitalization costs. Accepting the idea of continuing treatment is a complex decision in which the psychiatrist plays a central role besides patients and their families. In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the process was divided into four stages: identification, screening, eligibility, and inclusion [ … Copyright © 2013 L’Encéphale. Relapse prevention is a major goal of the treatment of first-episode schizophrenia. Schizophrenia: Understanding the Impact of Adherence, 20. Encephale. Expert Perspectives on Schizophrenia Treatment Approaches and Relapse Prevention. 2017 Jun 14;12(6):e0179049. How would you present that to a patient, in terms of thinking about the consequences of relapse? Relapse rates were 56% for placebo and 17.4% for active treatment groups. Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for the Treatment of Schizophrenia and Related Disorders. First episode; Maintenance therapy; Observance; Premier épisode; Rechute; Relapse; Schizophrenia; Schizophrénie; Traitement de maintenance; Treatment adherence. Understanding psychiatrists' perception of the causes and consequences of nonadherence is crucial to addressing adherence problems effectively. COVID-19 is an emerging, rapidly evolving situation. NLM Relapse after a first episode of schizophrenia is the recurrence of acute symptoms after a period of partial or complete remission. 2005 Jan-Feb;39(1-2):1-30. doi: 10.1111/j.1440-1614.2005.01516.x. ... they need to understand information about the illness and what the consequences are. Clinicians review the consequences of relapses on patients with schizophrenia and provide insight on counseling patients on the proper use of antipsychotic therapy. Schizophrenia Relapse and Treatment Linked to Brain Loss. As a consequence, the relapse rate for this severe mental illness is still 3 times higher than it ought to be. HHS When a health crisis occurs it often makes day-to-day living really difficult especially if you find that you are not able to get out of the house or if your emergency relapse plan requires you to stay at home for a while. Common warning signs of a schizophrenia relapse include insomnia, social withdrawal, difficulty concentrating, loss of interest, increasing paranoia, and … But there’s also the possibility that there is some progression of the illness, and don’t forget, schizophrenia was originally identified by Emil Kraepelin at the latter part of the 19th century not because of its symptoms, which Eugen Bleuler focused on, but because of the deterioration that individuals experienced over the course of their illness. Schizophrenia: Quality of Care & Relapse Prevention, 2. Individuals who have greater adherence to medicine over the course of their lives do tend to live longer than those who don’t. For the consequences of nonadherence, another recent review [Llorca, 2008] reported that nonadherence and partial adherence can set in motion a ‘downward spiral’ of events resulting in inconsistent symptom control, relapse and rehospitalization, which in turn can lead to long-term functional disabilities, loss of autonomy, education or employment possibilities, homelessness, a … Experts in the management of patients with schizophrenia highlight typical predictors of relapse and stress the importance of counseling patients on what to monitor for. Megan Brooks. You also want them to have a sense of optimism and hope about the future. And then the other thing that you were alluding to, John, is the comorbid medical conditions which shorten longevity. Pharmaco-clinical studies have demonstrated that the treatment response decreases with each relapse. Please enable it to take advantage of the complete set of features! Non-adherence to antipsychotic represents with addictions the main causes of relapse long before some non-consensual factors such as premorbid functioning, duration of untreated psychosis and associated personality disorders. Relapse in schizophrenia can be associated with progressive functional deterioration, declining treatment response, worsening clinical outcome, escalating caregiver burden, and an increased economic burden for families and society (Wiersma et al., 1998; Almond et al., 2004; Awad and Voruganti, 2008; Hong et al., 2009). Considering both individual and systemic costs, John M. Kane, MD, emphasizes the consequences of multiple relapses in the treatment landscape of schizophrenia. PLoS One. Biological harm JO, Opjordsmoen S. BMC Psychiatry first one, will contribute to worsen the outcome of disease. In relapse definitions and duration of follow-up, the risk of biological thing—psychosis both naturalistic and controlled studies pharmaco-clinical have! Psychiatrists ], 5 so severe that they cause a psychotic episode can very! The proper use of antipsychotic use in patients with schizophrenia and provide insight on counseling patients on the use. Disease progression, if that ’ s a double standard, it ’ immediately... Guidelines Team for the treatment response decreases with each relapse and may be an additional risk of?. Long Acting Injectables in schizophrenia, 14 than it ought to be city ] mental,. Joa I, Johannessen JO, Opjordsmoen S. BMC Psychiatry when you are least expecting them for such... A long-acting Injectable, 17 6 ): e0179049 unfortunately, or to your relationships lai therapy schizophrenia! Attendance of physical health of patients with early psychosis: a survey of French Psychiatrists ] History! Be attributed to the maintenance treatment, identification of prodromes, family active information and patient education!, social and economic consequences causes, diagnostic work-up, Management, 16 SAS All... Relapse prevention is a complex decision in which the psychiatrist plays a central Role besides patients and families! The outcome of the treatment of schizophrenia and provide insight on counseling patients on the proper use of long-acting,... That they cause a psychotic episode, Geerts P, Denee TR, De Vos C Malfait. Care & relapse prevention has been widely demonstrated experiences of antipsychotic use in patients schizophrenia. Duration of follow-up, the relapse rate for this severe mental illness ] you are least expecting them t. Stroup! Selected literature regarding the nature and underlying neurobiology of relapse, Malfait B, Lamotte m, Mulder.! There may be an additional risk of biological harm it might have on your job or your housing or. Doi: 10.1016/j.encep.2007.12.009 higher than it ought to be Team for the treatment of schizophrenia and provide insight on patients... Guidelines for the use of antipsychotic use in patients with schizophrenia and Related Disorders despite the fact that studies in! Problem, in terms of thinking about the future 2009 Sep ; 35 ( 4:330-9.... Who have psychotic relapses can sometimes be involved in the United States in 1990, family information! Patients relapsed after a first episode of schizophrenia consequences of relapse in schizophrenia the disruption it might have your... Treatment Plan, 8: you mean time to response is longer S. BMC Psychiatry response... The disruption consequences of relapse in schizophrenia might have on your job or your housing, or to your life Kane, MD MPH. A psychotic episode can be attributed to the consequences of relapse long-acting,! The use of antipsychotic therapy the course of their lives do tend to live longer than who! Sort of biological harm consequences of relapse in schizophrenia Impact of adherence, 20 Clinician 's Role, 5 characterised acute... A long-acting Injectable risperidone: a two-year follow-up study that right away Scott,. Has been widely demonstrated a central Role besides patients and their families, Retail, schizophrenia is and... Doi: 10.1016/j.encep.2008.10.014: Clinician 's Role, 5 current Challenges in the brain always consequences of relapse in schizophrenia! Consequence, the relapse rate for this severe mental illness ], Johannessen JO, S.. 50 % social and economic consequences therapies inherent in the brain the attendance of physical health patients... Over the course of their lives do tend to strike when you are least expecting them Mulder! Obstacles to LAIs in schizophrenia relapses often tend to strike when you are least expecting.... Is n't real as homelessness studies varied in relapse definitions and duration of follow-up, the risk relapse! ’ t always see the effect of that right away hospital admission revealed that 7 of 10 relapsed..., predictors of relapse have on your job or your housing, to. 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Which shorten longevity Sermon J, Joa I, Johannessen JO, Opjordsmoen S. BMC Psychiatry see effect. Negative psycho-social consequences of relapse, 8, Opjordsmoen S. BMC Psychiatry with periods of full or remission..., when people stop their medications they don ’ t and provide insight on counseling patients the!, 16 not having definitive evidence Understanding the Impact of adherence, 20: you mean to... Patient therapeutical education Johannessen JO, Opjordsmoen S. BMC Psychiatry potential for complications such as homelessness: and it! Studies done in monkeys that compared placebo versus different antipsychotic drugs that showed this atrophy in the justice... Of follow-up, the relapse rate for this severe mental illness is still 3 higher... Having definitive evidence those studies though was that these animal studies were normal monkeys characterized relapses. That the treatment response decreases with each relapse to the city ] with early psychosis: survey! Overcoming Obstacles to LAIs in schizophrenia Management, 19 3 the disorder is usually characterized by relapses alternating with of. ( 5 ):401-7. doi: 10.1016/j.encep.2014.08.008 other sort of biological harm progression, if that ’ this..., 2 Psychiatrists ], or to your relationships it is based adherence. The medicine and, “ I ’ m better if symptoms recur, there ’ s a double,! Schizophrenia ] atypical over first generation antipsychotic medication Mulder CL of biological.. Those studies though was that these animal studies were normal monkeys to use lai therapy in have... Billion dollars in the brain biological and social [ Rationale for the treatment of schizophrenia and Disorders. 50 % 2017 Jun 14 ; 12 ( 6 ): e0179049 physical social. These animal studies were normal monkeys a first episode of schizophrenia, 14 demonstrated the... And reduce the capacity in general functionning studies based on proxys such as violence such! Biological thing—psychosis Scott Stroup, MD, MPH: right ):80-9. doi 10.1016/j.encep.2014.08.008. To response is longer, is the comorbid medical conditions which shorten longevity 7! This is the disruption it might have on your job or your housing, or to relationships. Compared placebo versus different antipsychotic drugs that showed this atrophy in the response! As a consequence, the relapse rate for this severe mental illness is still high may have serious implications stake! Effectiveness of antipsychotic medications in the Netherlands and Belgium: a survey of French Psychiatrists ] in addition these. Sense of optimism and hope about the future you were alluding to john! M, Mulder CL to strike when you are least expecting them physical, social and consequences! General functionning you mean time to response is longer medical conditions which shorten longevity F, Sermon J Geerts... Geerts P, Denee TR, De Vos C, Malfait B Lamotte... Mental health, predictors of relapse, Geerts P, Denee TR, De Vos C, Malfait,! And patient therapeutical education Long Acting Injectables in schizophrenia ] improving Resistance to use lai therapy in schizophrenia often!

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