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.
EPA : European Psychiatric Association
QoL : Quality of Life
LATS : Long-acting therapies
UK : United Kingdom
LAI : Long-acting injectable
BE-NOTPR-0188, approval date : 08.2022
