Schizophrenia: Critical Management Issues in First-Episode and Chronic Patients
| Start Date |
Saturday, October 18, 2008 |
| End Date |
Saturday, October 18, 2008 |
| Description |
Schizophrenia is a serious neuropsychiatric disorder that often leads to life-long impairment in societal functioning. Unfortunately, despite the availability of effective medications, the illness is too frequently characterized by incomplete remission after an acute psychotic episode, or a relapse after full remission because of insufficient adherence to antipsychotics.
It is estimated that adherence rates among patients with schizophrenia are between 50 and 60 percent, and that 50% to 75% of patients with schizophrenia will relapse within a year if they discontinue their medication, compared to only 25% of patients who continue their medication. Poor adherence prevents patients with schizophrenia from enjoying the full spectrum of benefits of antipsychotic drugs. Even with good adherence, patients can face incomplete symptom response (including refractory psychosis) and a high comorbidity burden (including the metabolic syndrome) that must be managed.
a. First-episode patients:
In a recent survey of 113 practitioners, less than one third were able to correctly diagnose schizophrenia based on a vignette of a prototypical first-episode patient who had comorbid substance use. Approximately 54% of practitioners surveyed reported that non-adherence to treatment is the most important barrier in treating this patient. Despite guideline recommendations to treat patients for at least one year following a first-episode of schizophrenia, in a typical cohort of first-episode patients less than 50% of first-episode patients are sufficiently adherent during the first 12 months of treatment, suggesting the potential for improvement on the management of non-adherence.
b. Multi-episode (chronic) patients:
41% of patients in the CATIE sample were diagnosed with the metabolic syndrome, and this cohort had a greatly increased 10-year cardiovascular risk estimate compared to the normal population. Since the CATIE cohort is representative of the typical patient with chronic schizophrenia in the US, the cardiovascular risk factor findings suggest the need for psychiatrists to be able to recognize and manage metabolic problems associated with antipsychotics and schizophrenia. Since a significant minority of patients with schizophrenia will be insufficiently treated with first-line antipsychotics monotherapy, psychiatrists should be able to offer rational antipsychotic combinations and clozapine. Psychiatrists in the US are under prescribing clozapine, leading the authors of CATIE to recommend the establishment of clozapine clinics where clozapine can be prescribed competently and responsibly.
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| Contact Name |
Glenn Laudenslager |
| E-mail |
mghsupport@reedmeded.com |
| Website |
http://www.mghcme.org/?page=events/details&eventid=5186 |
| Format |
Conferences, Lecture, Seminar |
| Location |
MGH Simches Research Building
Starr Center, 2nd Floor
Boston, Massachusetts
|
| Credit Hours |
maximum of 6 AMA PRA Category 1 Credit(s) |
| Credit Category |
AMA |
| Price |
$40.00 |
| Register by date |
Saturday, October 18, 2008 |
| Objectives |
Upon completion of this activity, participants should be able to:
Differentiate initial treatment goals for patients with first-episode schizophrenia
Discuss a reasoned work-up to exclude medical causes of psychosis
Examine key factors contributing to poor adherence in first-episode and chronic patients
Manage long-term side effects associated with antipsychotics
Determine strategies to address treatment-refractory positive symptoms including the use of clozapine
Describe the role of psychosocial strategies in enhancing treatment adherence |
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