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Evolution of symptoms with antipsychotic treatment in schizophrenic outpatients in Greece: the GRACE Study


To describe positive, negative and other symptoms evolution following treatment change, in schizophrenic patients in Greece.

Materials and methods

The GRACE study was a non-interventional observational, multicentre national survey. It involved 104 centres, proportionally distributed over Greece and observed patients diagnosed and treated for schizophrenia in the outpatients setting over a period of 12 months spanning from June 2007 till June 2008. Demographic and other patient characteristics including family status, educational level, living status, employment status, and centres monitoring patient's condition were recorded. Positive (aggressive behaviour, disorganised speech/thinking, illusions, delusions), negative (affective flattening, blunted effect, avolition, social isolation) and other (affective symptoms, aggressiveness, sleep disorders, cognitive disorders) symptom changes were recorded and analysed prior and post treatment change. Statistical analysis was performed by McNemar's Chi square statistic.


In total, 2013 patients, mean age 39.7 ± 12.5, were included in the study, 54.4% of which were males and 45.6% females. Most of the patients were unmarried (64%), living with their family (64.4%) and unemployed (54.2%) at the time of screening. After treatment change to another antipsychotic agent positive symptoms significantly decreased by 23.6% (p < 0.005), negative symptoms remained unchanged and other symptoms significantly decreased by 15.9% (p < 0.05). Illusions, delusions and disorganised speech/thinking, were the positive symptoms with the most profound decrease (14% p < 0.001, 13.1% p < 0.001 and 5.4% p < 0.005 respectively). No significant changes were observed in affective flattening, aggressiveness, sleep and cognitive disorders. All administered antipsychotic treatments were associated with significant decrease in positive symptoms, with ziprasidone, olanzapine, rispesridone, quetiapine, aripiprazole, and aminosulpride showing more than 20% decrease (p < 0.001). Ziprasidone, aripiprazole, cloazapine, quetiapine and aminisulrpide were associated with decrease in negative treatments, however only ziprasidone and ariprazole decreases reached significance (p < 0.01 and p < 0.02 respectively. All agents, showed significant decrease in other symptoms (p < 0.001).


Negative symptoms remain difficult to control showing inconsistent patterns of symptom responsiveness. Currently available second generation antipsychotic agents appear to have minor to modest benefits on negative symptoms. All administered antipsychotics seem to have equal effectiveness in suppressing positive symptoms presented by schizophrenic patients in Greece.

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Correspondence to Dimitra Karadima.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Karadima, D., Chatzimanolis, I., Tsebelikos, E. et al. Evolution of symptoms with antipsychotic treatment in schizophrenic outpatients in Greece: the GRACE Study. Ann Gen Psychiatry 9, S93 (2010).

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  • Schizophrenia
  • Olanzapine
  • Quetiapine
  • Sleep Disorder
  • Negative Symptom