Improving outcomes for patients with schizophrenia – Patient centric approach

Improved treatment outcomes for patients with schizophrenia can be achieved by tailoring management for an individual patient’s treatment and recovery goals with shared decision-making and early use of long-acting antipsychotics and psychosocial interventions, explained three experts at EPA 2022.

Tailoring management for an individual patient’s treatment and recovery goals

Treatment success depends on early intervention services providing effective pharmacotherapy and psychosocial interventions

Recovery is a multidimensional outcome for patients with schizophrenia,1 said Professor Christoph Correll, Berlin, Germany, and can be achieved by management that targets many clinical domains and personalized goals.2

Personalized treatment success requires not only effective pharmacotherapeutic control of the individual patient’s symptoms of schizophrenia and comorbidities,3 but also a variety of psychosocial interventions and support to improve psychosocial functioning at home, in personal relationships, and in social, educational, and work environments.4

Continued or recurrent psychotic symptoms undermine treatment goals

The overlap between the dimensions of symptom and functional remission and quality of life (QoL) in first-episode schizophrenia has been demonstrated by a 24-month follow-up study of 98 patients treated with a long-acting antipsychotic, said Professor Correll. Psychopathology and functionality improved, mainly within the first 6 months, while improvement in QoL was slower but reached significance at 12 months. Overall, 29% of patients experienced a full recovery defined as symptom and functional remission with a good overall QoL, but only 9% of patients without symptom remission had a functional remission and good QoL.5

Continued or recurrent psychotic symptoms undermine treatment goals, concluded Professor Correll, and patients in the early phase of schizophrenia, who are closest to their premorbid functioning, have the most to gain from multidimensional early intervention services vs treatment as usual.6

 

Importance of long-acting antipsychotics and shared decision-making

Long-acting antipsychotics and shared decision-making improve outcomes

Early use of long-acting therapies (LATs) improves treatment outcomes for patients with schizophrenia, said Dr Sofia Pappa, London, UK.

The efficacy of long-acting injectable (LAI) antipsychotic treatment compared with oral antipsychotics has been confirmed by a systematic review and meta-analysis that identified 25 mirror-image studies comparing periods of oral antipsychotics against LAIs, explained Dr Pappa. Mirror-image studies were used rather than randomized controlled trials to better reflect the real-world clinical use of antipsychotics. The LAIs showed strong superiority over oral antipsychotics in preventing and decreasing the number of hospitalizations.7

Long-acting injectable antipsychotics show strong superiority over oral antipsychotics in preventing and decreasing the number of hospitalizations

Optimal outcomes for patients with schizophrenia are achieved by combining LATs and a patient-centered approach in early illness, confirmed Professor Robin Emsley, Cape Town, South Africa. Offering LATS in the context of shared decision-making is associated with excellent patient acceptance of LATS.8

Professor Robin Emsley highlighted that shared decision-making is an intermediate model of decision-making between the paternalistic approach where the doctor makes decisions alone, as in an emergency situation, and the informed choice position where the patient is provided with information and decides alone.

In shared decision-making, the doctor and patient decide upon the optimal treatment and management together

In shared decision-making, techniques such as motivational interviewing are used so the doctor and patient can evaluate the patient’s clinical needs and personal goals and decide upon the optimal treatment and management together.9

This symposium was sponsored by Janssen.

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

IE-NPSCZ-0024

References
  1. Correll CU, Kishimoto T, Nielsen J, Kane JM. Quantifying clinical relevance in the treatment of schizophrenia. Clin Ther. 2011;33(12):B16–39.
  2. Correll CU. Using patient-centered assessment in schizophrenia care: defining recovery and discussing concerns and preferences. J Clin Psychiatry. 2020;81(3):MS19053BR2C.
  3. Abdullah HM, Azeb Shahul H, Hwang MY, Ferrando S. Comorbidity in schizophrenia: Conceptual issues and clinical management. Focus (Am Psychiatr Publ). 2020;18(4):386–90.
  4. Burns T, Patrick D. Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand. 2007;116(6):403–18.
  5. Phahladira L, Luckhoff HK, Asmal L, et al. Early recovery in the first 24 months of treatment in first-episode schizophrenia-spectrum disorders. NPJ Schizophr. 2020;6(1):2.
  6. Correll CU, Galling B, Pawar A, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry. 2018;75(6):555–65.
  7. Kishimoto T, Nitta M, Borenstein M, Kane JM, Correll CU. Long-acting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. J Clin Psychiatry. 2013;74(10):957–65.
  8. Chiliza B, Ojagbemi A, Esan O, et al. Combining depot antipsychotic with an assertive monitoring programme for treating first-episode schizophrenia in a resource-constrained setting. Early Interv Psychiatry. 2016;10(1):54–62.
  9. Hamann J, Heres S. Adapting shared decision making for individuals with severe mental illness. Psychiatr Serv. 2014;65(12):1483–6.
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