Improving treatment adherence in patients with early-phase schizophrenia

Early treatment engagement and a robust treatment response in patients with schizophrenia may be a mechanism for better treatment adherence over the long term.Strategies for improving adherence in early-phase patients include more effective patient communication and use of long-acting injectables.

The rationale for initiating treatment early in the course of schizophrenia includes the potential for greater efficacy of medication and the potential to delay or interrupt the disease process.1,2 An early robust treatment response may also be a mechanism to promote treatment adherence over the long term. "There is only one opportunity to make a good first impression", said Professor Schooler, Suny Downstate Health Sciences Center, Brooklyn, New York in her Plenary presentation at SIRS 2022.

Initiating treatment early in the course of schizophrenia includes the potential for greater efficacy and the potential to delay the disease process

 

Why do early-phase patients stop taking medication?

"There are several reasons why patients stop taking their medication. Interestingly, non-adherence is often different in patients early in the course of treatment than in those more experienced with medication. Younger patients, with early-phase schizophrenia, often consider their illness in the same light they would an infectious disease. After these patients have received treatment and feel themselves as ‘better’, they often no longer want to take the treatment", explained Professor Schooler.

"The patient-therapist relationship is a critical element of successful outcomes in schizophrenia, but it may also contribute to non-adherence" said Professor Schooler. "Paradoxically, patients who have positive therapist relationships and alliances may feel a desire to please the therapist and therefore do not reveal their non-adherence".

Early-stage patients can be more sensitive to potential adverse effects of medication

"The use of lower doses and careful titration are important for patients with early-phase schizophrenia" explained Professor Schooler. "Even at low doses, early-phase patients can be more sensitive to potential adverse effects of medication compared with medication experienced patients, and adverse effects lead to non-adherence and discontinuation. It’s important that patients are properly prepared for potential adverse effects of medication".

Early use of an LAI could decrease relapse and improve adherence

Improving response and adherence with LAIs in early-phase schizophrenia

The benefits of long-acting injectables (LAIs) in early-phase schizophrenia include lower rates of relapse and improved adherence.3,4 In a study conducted in the US, which evaluated a once-monthly LAI versus clinician’s choice* usual care in patients with early-phase schizophrenia, the once-monthly LAI group resulted in a significant (44%) delay in first hospitalization compared with usual care.3

Introduction of an LAI well before documented evidence of non-adherence can be a useful strategy to improve adherence

"Introduction of an LAI well before documented evidence of non-adherence can be a useful strategy to improve adherence" said Professor Schooler. "Understanding that LAI treatment does not depend on demonstrated non-adherence and thoroughly communicating the benefits and side effects of LAI medication to early-phase patients is essential".

(*) Clinician’s choice (usual care) group may also contain LAIs pre-protocol

 

SIRS : Schizophrenia International Research Society
LAI : long-acting injectable
US : United States 

BE-NOTPR-0162, approval date : 06.2022 

 

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.

References
  1. Drake RJ, et al. Effect of delaying treatment of first-episode psychosis on symptoms and social outcomes: a longitudinal analysis and modelling study. Lancet Psychiatry 2020;7:602─610.
  2. Kahn RS, Sommer IE. The neurobiology and treatment of first-episode schizophrenia. Mol Psychiatry 2015;20:84─97.
  3. Kane JM, et al. Effect of Long-Acting Injectable Antipsychotics vs Usual Care on Time to First Hospitalization in Early-Phase Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry 2020;77:1217─1224.
  4. Correll CU, et al. The Use of Long-Acting Injectable Antipsychotics in Schizophrenia: Evaluating the Evidence. J Clin Psychiatry 2016;77(suppl 3):1─24. 
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