Epidemiology and Treatment Guidelines of Negative Symptoms in Schizo-phrenia in Central and Eastern Europe: A Literature Review

Monika Szkultecka-Dębek 1, *, Jacek Walczak 2, Joanna Augustyńska 2, Katarzyna Miernik 2, Jarosław Stelmachowski 2, Izabela Pieniążek 2, Grzegorz Obrzut 2, Angelika Pogroszewska 2, Gabrijela Paulić 3, Marić Damir 3, Siniša Antolić 3, Rok Tavčar 4, Andra Indrikson 5, Kaire Aadamsoo 6, Slobodan Jankovic 7, Attila J Pulay 8, József Rimay 9, Márton Varga 9, Ivana Sulkova 10, Petra Veržun 11
1 Roche Polska Sp. z o.o., Warsaw, Poland
2 Arcana Institute, Cracow, Poland
3 Roche Ltd, Zagreb, Croatia
4 University Psychiatric Clinic Ljubljana, Slovenia
5 Roche Eesti OÜ, Tallinn, Estonia
6 Psychiatry Clinic, North Estonia Medical Centre, Tallinn, Estonia
7 Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
8 Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary
9 Roche (Magyarország) Kft, Budaörs, Hungary
10 Roche Slovensko, s.r.o., Bratislava, Slovakia
11 Roche d.o.o. Slovenia, Ljubljana, Slovenia

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© Szkultecka-Dębek et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Roche Polska Sp. z o.o., Warsaw, Poland; Tel: + 48 22 345 17 92; Fax: +48 22 345 18 82; E-mail:


Aim : To gather and review data describing the epidemiology of schizophrenia and clinical guidelines for schizophrenia therapy in seven Central and Eastern European countries, with a focus on negative symptoms. Methods : A literature search was conducted which included publications from 1995 to 2012 that were indexed in key databases. Results : Reports of mean annual incidence of schizophrenia varied greatly, from 0.04 to 0.58 per 1,000 population. Lifetime prevalence varied from 0.4% to 1.4%. One study reported that at least one negative symptom was present in 57.6% of patients with schizophrenia and in 50–90% of individuals experiencing their first episode of schizophrenia. Primary negative symptoms were observed in 10–30% of patients. Mortality in patients with schizophrenia was greater than in the general population, with a standardized mortality ratio of 2.58–4.30. Reasons for higher risk of mortality in the schizophrenia population included increased suicide risk, effect of schizophrenia on lifestyle and environment, and presence of comorbidities. Clinical guidelines overall supported the use of second-generation antipsychotics in managing negative symptoms of schizophrenia, although improved therapeutic approaches are needed. Conclusion : Schizophrenia is one of the most common mental illnesses and poses a considerable burden on patients and healthcare resources alike. Negative symptoms are present in many patients and there is an unmet need to improve treatment offerings for negative symptoms beyond the use of second-generation antipsychotics and overall patient outcomes.

Keywords: Epidemiology, guidelines, mortality, negative symptoms, pharmacotherapy, schizophrenia.