title: Model of Management (Mo.Ma) for the patient with schizophrenia: crisis control, maintenance, relapse prevention, and recovery with long-acting injectable antipsychotics (LAIs).
abstract: Schizophrenia is a severe mental disease that affects approximately 1% of the population with a relevant chronic impact on social and occupational functioning and daily activities. People with schizophrenia are 2-2.5 times more likely to die early than the general population. Non-adherence to antipsychotic medications, both in chronic and first episode schizophrenia, is one of the most important risk factors for relapse and hospitalization, that consequently contributes to increased costs due to psychiatric hospitalization. Atypical long-acting injectable (LAI) antipsychotics can improve treatment adherence and decrease re-hospitalization rates in patients with schizophrenia since its onset. The primary goals in the management of schizophrenia are directed not only at symptom reduction in the short and long term, but also at maintaining physical and mental functioning, improving quality of life, and promoting patient recovery.
  
  
  
  To propose a scientific evidence-based integrated model that provides an algorithm for recovery of patients with schizophrenia and to investigate the effectiveness and safety of antipsychotics LAI in the treatment, maintenance, relapse prevention, and recovery of schizophrenia.
  
  
  
  After an accurate literature review we identified, collected and analyzed the crucial points in taking care schizophrenia patients, through which we defined the steps described in the model of management and the choice of the better treatment option. Results. In the management model we propose, the choice of a second generation long acting antipsychotic, could allow from the earliest stages of illness better patient management, especially for young individuals with schizophrenia onset, a better recovery and significant reductions of relapse and health care costs. LAI formulations of antipsychotics are valuable, because they help patients to remain adherent to their medication through regular contact with healthcare professionals and to prevent covert non-adherence.
  
  
  
  The proposed schizophrenia model of management could allow better patient management and recovery, in which the treatment with LAI formulation is a safe and effective therapeutic option. This new therapeutic approach could change the cost structure of schizophrenia by decreasing costs with efficient economic resource allocation guaranteed from efficient diagnostic and therapeutic pathways.
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Brugnoli
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.affiliation: Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marcellusi
authors.affiliation: Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Italy.
authors.forename: Francesco S
authors.initials: FS
authors.lastname: Mennini
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy - Villa von Siebenthal Neuropsychiatric, Clinic and Hospital Rome, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: De Filippis
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy - ASL VT, Viterbo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Carrus
authors.affiliation: Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballerini
authors.affiliation: Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Francomano
authors.affiliation: DSMASL Roma 1, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ducci
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy - Department of Psychiatric Rehabilitation, Fondazione ''P. Alberto Mileno Onlus'', Vasto (CH), Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.affiliation: NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D000465:Algorithms; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D019468:Disease Management; D004311:Double-Blind Method; D042241:Early Diagnosis; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D055118:Medication Adherence; D008962:Models, Theoretical; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics / Q000534:rehabilitation
chemical_list: D014150:Antipsychotic Agents; D003692:Delayed-Action Preparations