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Schizophrenia effectiveness treatment


Towards a framework for treatment effectiveness in schizophrenia

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Schizophrenia - Diagnosis and treatment

Diagnosis

Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to substance abuse, medication or a medical condition. Determining a diagnosis of schizophrenia may include:

  • Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
  • Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
  • Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This also includes a discussion of family and personal history.
  • Diagnostic criteria for schizophrenia. A doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

More Information

  • CT scan
  • MRI

Treatment

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.

A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Medications

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They're thought to control symptoms by affecting the brain neurotransmitter dopamine.

The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.

Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example, someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill.

Ask your doctor about the benefits and side effects of any medication that's prescribed.

Second-generation antipsychotics

These newer, second-generation medications are generally preferred because they pose a lower risk of serious side effects than do first-generation antipsychotics. Second-generation antipsychotics include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Clozapine (Clozaril, Versacloz)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

First-generation antipsychotics

These first-generation antipsychotics have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. First-generation antipsychotics include:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine

These antipsychotics are often cheaper than second-generation antipsychotics, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

Long-acting injectable antipsychotics

Some antipsychotics may be given as an intramuscular or subcutaneous injection. They are usually given every two to four weeks, depending on the medication. Ask your doctor about more information on injectable medications. This may be an option if someone has a preference for fewer pills and may help with adherence.

Common medications that are available as an injection include:

  • Aripiprazole (Abilify Maintena, Aristada)
  • Fluphenazine decanoate
  • Haloperidol decanoate
  • Paliperidone (Invega Sustenna, Invega Trinza)
  • Risperidone (Risperdal Consta, Perseris)

Psychosocial interventions

Once psychosis recedes, in addition to continuing on medication, psychological and social (psychosocial) interventions are important. These may include:

  • Individual therapy. Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
  • Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.
  • Family therapy. This provides support and education to families dealing with schizophrenia.
  • Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.

Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their illness.

Hospitalization

During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

Electroconvulsive therapy

For adults with schizophrenia who do not respond to drug therapy, electroconvulsive therapy (ECT) may be considered. ECT may be helpful for someone who also has depression.

More Information

  • Family therapy

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Coping and support

Coping with a mental disorder as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Here are some ways to cope:

  • Learn about schizophrenia. Education about the disorder can help the person with schizophrenia understand the importance of sticking to the treatment plan. Education can help friends and family understand the disorder and be more compassionate with the person who has it.
  • Stay focused on goals. Managing schizophrenia is an ongoing process. Keeping treatment goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the disorder and working toward goals.
  • Avoid alcohol and drug use. Using alcohol, nicotine or recreational drugs can make it difficult to treat schizophrenia. If your loved one is addicted, quitting can be a real challenge. Get advice from the health care team on how best to approach this issue.
  • Ask about social services assistance. These services may be able to assist with affordable housing, transportation and other daily activities.
  • Learn relaxation and stress management. The person with schizophrenia and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.
  • Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.

Preparing for your appointment

If you're seeking help for someone with schizophrenia, you may start by seeing his or her family doctor or health care professional. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist.

What you can do

To prepare for the appointment, make a list of:

  • Any symptoms your loved one is experiencing, including any that may seem unrelated to the reason for the appointment
  • Key personal information, including any major stresses or recent life changes
  • Medications, vitamins, herbs and other supplements that he or she is taking, including the dosages
  • Questions to ask the doctor

Go with your loved one to the appointment. Getting the information firsthand will help you know what you're facing and what you need to do for your loved one.

For schizophrenia, some basic questions to ask the doctor include:

  • What's likely causing the symptoms or condition?
  • What are other possible causes for the symptoms or condition?
  • What kinds of tests are needed?
  • Is this condition likely temporary or lifelong?
  • What's the best treatment?
  • What are the alternatives to the primary approach you're suggesting?
  • How can I be most helpful and supportive?
  • Do you have any brochures or other printed material that I can have?
  • What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

The doctor is likely to ask you a number of questions. Anticipating some of these questions can help make the discussion productive. Questions may include:

  • What are your loved one's symptoms, and when did you first notice them?
  • Has anyone else in your family been diagnosed with schizophrenia?
  • Have symptoms been continuous or occasional?
  • Has your loved one talked about suicide?
  • How well does your loved one function in daily life — is he or she eating regularly, going to work or school, bathing regularly?
  • Has your loved one been diagnosed with any other medical conditions?
  • What medications is your loved one currently taking?

The doctor or mental health professional will ask additional questions based on responses, symptoms and needs.

By Mayo Clinic Staff

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Breakthrough in the treatment of schizophrenia: Janssen's new drug Trevicta is registered in Russia

Breakthrough in the treatment of schizophrenia: New drug Trevicta by Janssen is registered in Russia

Janssen, Johnson & Johnson Pharmaceutical Division ”, announces the registration in Russia of a new drug “Trevicta” (long-acting paliperidone palmitate) with a regimen of administration once every three months) for the maintenance treatment of patients with schizophrenia, which can significantly increase the interval between antipsychotic injections and use the drug 4 times a year, instead of monthly administration, as in the current use of injectable prolonged forms. nine0003

Trevicta is currently the antipsychotic with the longest dosing interval between two uses among all antipsychotics registered in Russia[1], which ensures the maintenance of the optimal concentration of the drug in the blood of patients and, accordingly, the lowest frequency of its use. Trevicta is prescribed only to those patients whose condition was stable during previous therapy with Xeplion (paliperidone palmitate, used to treat schizophrenia once a month). The 3-monthly paliperidone palmitate dosage form may be a valuable treatment option for patients with schizophrenia because the extended half-life of paliperidone may reduce the risk of relapse for an extended period after the last injection. The results of a placebo-controlled study of the drug "Trevikta" showed that about 95% of patients were stabilized for more than 1 year on therapy, and the median time to relapse was 274 days.

Ekaterina Pogodina, Executive Director of Janssen in Russia, said: “Schizophrenia and the expansion of Russian patients' access to modern therapy for this disease, in our opinion, require more attention from both the state and society today. The medical aspect is also extremely relevant - ensuring adherence to treatment, maintaining a stable condition of the patient and the absence of relapses. Today, thanks to the registration of the innovative drug Trevicta, Russian healthcare has taken a big step towards solving the problem of socialization and adaptation of patients with this disease.” nine0003

President of the Russian Society of Psychiatrists, Director of the St. Petersburg Research Psychoneurological Institute. V.M. Bekhtereva, MD, prof. Nikolai Grigoryevich Neznanov said: “The first 5 years of schizophrenia are a critical period in relation to the clinical and social consequences of the disease, and it is extremely important at this stage to provide intensive biopsychosocial assistance to patients aimed at improving the long-term prognosis. The level of relapses in such patients is very high due to poor compliance with the therapy regimen, and one of the conditions for a favorable prognosis of the disease is the quality of remission, which is associated both with the control of productive symptoms and, to a greater extent, with the effectiveness of the impact of therapy on negative, cognitive and affective disease symptoms. An important factor in providing maintenance therapy is the adherence of patients to treatment, which largely depends on the combination of the effectiveness and tolerability of psychopharmacotherapy. In this regard, injectable long-acting atypical antipsychotics meet all modern requirements and approaches to the treatment of patients with schizophrenia.” nine0003

Schizophrenia is a serious mental illness that leads to significant clinical and socioeconomic consequences: poor adherence to therapy increases the risk of negative outcomes of the disease, including relapses, readmissions, suicides, and, accordingly, increases the socioeconomic burden of the disease. In addition, schizophrenia is characterized by frequent hospitalizations (rehospitalization rate was 40%) and high patient disability (66% of the total number of patients with schizophrenia with disabilities) in the Russian Federation according to the latest data. More than 60% of the burden of schizophrenia in the Russian Federation is made up of indirect costs, including: GDP losses, payments due to temporary disability, monthly cash payments, disability pensions. nine0003

According to the Moscow Research Institute (NII) of Psychiatry, at the end of 2014 in the Russian Federation alone, the total number of registered patients with schizophrenia was 372.1 per 100,000 population (in total - 544,192 people)[2].

[1] State Register of Medicines // http://www.grls.rosminzdrav.ru/Default.aspx

[2] Gurovich I.Ya., Shmukler A.B., Golland V.B. and others. Psychiatric service in Russia in 2006-2011. Dynamics of indicators and analysis of development processes: monograph. Moscow:, 2012. 600 p. (updated data for 2012-2014)

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Alexey Shavenzov / [email protected]

+7 495 755 8357 (ext. 2078)

Data from a new study in the treatment of schizophrenia Medvestnik

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New study data in...

New data on the use of cariprazine in the treatment of negative symptoms of schizophrenia were presented at the 28th Annual Meeting of the European Psychiatric Association (EPA), held online July 4-7, 2020. nine0003

In an observational study conducted in outpatient psychiatric hospitals, the positive effect of the drug on the negative symptoms of schizophrenia in those patients for whom previous therapy was ineffective was confirmed, as well as a favorable safety profile of the drug. The study also showed that the effect of cariprazine on changes in heart rate and QT interval is minimal, comparable to placebo. In addition, a retrospective analysis of the use of cariprazine and risperidone showed that only cariprazine had a positive effect on negative symptoms in patients during an exacerbation of the disease. nine0003

Schizophrenia is a chronic mental illness characterized by positive and negative symptoms, behavioral disorders and cognitive impairment. In the world, this disease affects about 1% of the population; 5 million people in the European Union struggle with schizophrenia. Negative symptoms of the disease appear in almost 60% of patients and have a significant impact on their daily life. Antipsychotics have been proven to be effective in treating the positive symptoms of the disease, but treating the negative symptoms of schizophrenia remains a huge challenge for modern medicine. nine0003

In double-blind studies, cariprazine has already proven effective in treating all symptoms of schizophrenia , however, it was important to obtain real clinical practice data in order to evaluate the effect of the drug on patients in their daily life. In Latvia, the manufacturer of cariprazine conducted a 16-week observational study involving 116 outpatients. The results showed that the drug had a positive effect on the relief of negative symptoms of schizophrenia in those patients who had not previously received the desired response to therapy. Also, when switching to treatment with cariprazine, the severity of the existing side effects of the previous therapy gradually decreased and no changes in weight were observed, which indicates a high safety profile of the drug. It is important to note that most physicians were extremely satisfied with the efficacy and good tolerability of cariprazine. nine0003

The following data were also presented at the EPA conference:

  • Long-term antipsychotic treatment is indicated for all patients with schizophrenia. Drugs can be very effective but have side effects such as cardiac complications. In this connection, a retrospective analysis of the effect of cariprazine on the cardiovascular system was carried out, which showed that the effect of the drug on the parameters of the heart is generally comparable to placebo. Changes in heart rate and QT interval were minimal, the incidence of adverse events associated with the cardiovascular system, as well as associated cases of discontinuation of treatment, were extremely rare. nine0049