Schizophrenia and the importance of carers – an interview with Dr Jose M. Crespo, Spain

How difficult is it to give patients the news that they have schizophrenia?

We want to give patients some hope and let them know that there are treatments that can help improve their quality of life.

Sometimes it’s more difficult to tell the family and carers of a patient than the patient themselves. Typically the conversation with the family and carers has to take place separately from the conversation with the patient – the process is usually to talk with the patient, then with the family and then maybe with both together. It is important to talk about the disease, its prognosis and the treatment.

We want to give the patient and the family some hope – and of course when we talk bout the possibility of a schizophrenia diagnosis for the first time – it may be that the diagnosis is still to be confirmed. When a diagnosis is confirmed after maybe after some months or following some further evolution, we want to give patients some hope and let them know that there are treatments that can help improve their quality of life.

I work in in-patient care – in a hospitalization unit – so I’m not the physician who will follow-up with the patient when they are back in the community. But of course – I do sometimes see the same patients again – if they are readmitted with new episodes.

What is autonomy and what is good function and quality of life for your patients with schizophrenia?

Quality of life in schizophrenia to me is all about supporting improvements that mean the person can work – get a job – and not to be in an institution or be a dependent resident somewhere. Keeping supporting independence. After the work we do with the patient, the next most important thing we do is work with family and carers  - it is key to achieving good function and quality of life. Family and carers are really important in helping patients with taking their treatment, with coming to appointments – they – the family and carers - are often the directors that really help the patient living with schizophrenia.

What role do you think your patients should have in defining their own treatment goals?

During an episode – patients are often not in a position to decide and during such times the psychiatrist and other professionals have to decide. But with time, the patient the patient can assume more of a role in deciding what happens once they leave the hospitalization unit.

How important is treatment adherence and compliance in helping patients to achieve their goals?

I use long-acting injectables (LAIs) and I think they really help. I’ve been working in this profession since 1999 and at that time there were depot treatment options – which I did use – but now we have more formulations and routes. Patients do well with LAIs. Of course some patients prefer oral treatments, others prefer LAIs – it’s personal – but when there isn’t good compliance and depending on the evolution of the disease  – I will want to change a patient to an LAI. I am happy to think about LAIs both in first episode and in chronic disease. If I think it’s necessary to prescribe an LAI, I will prefer that.

What do you think will be the next developments in schizophrenia care?

Well – one of the things is that many of the drugs we use today are the same as the drugs we had years ago – there have been no major breakthroughs in terms of new mechanisms of action. We need new drugs with new mechanisms. We are moving to towards a better understanding of how genetics affect drug handling and tolerance.