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Expert guidance on management of schizophrenia for a better quality of life and independence

Individualized patient management is key to achieving better lifetime quality of life and independence for patients with schizophrenia, explained Professor Ira Glick of Stanford University School of Medicine, Stanford, California. He described his learnings from 50-years of experience managing patients with schizophrenia and the latest research on how to achieve the best outcomes in an inspirational presentation for APA 2020 On Demand.

A team-based, shared decision-making approach individualized for each patient is required to achieve a successful lifetime management strategy for patients with schizophrenia, said Professor Glick, and needs to focus on:

The mortality gap for patients with schizophrenia is 15 years because many die prematurely due to inadequate treatment for medical diseases

  • balancing antipsychotic efficacy and safety
  • ensuring long-term antipsychotic adherence
  • treating associated medical risk factors and diseases
  • providing psychosocial support and education

 

Long-term antipsychotic adherence prevents relapse and rehospitalization

Choose the most “medically benign” effective antipsychotic for each individual patient

Not all antipsychotics are the same, said Professor Glick. There are marked differences between different antipsychotics in terms of their efficacy and in terms of their adverse effects.1 It is important to choose the most medically benign effective antipsychotic for each individual patient and manage medical adverse effects, such as acute and tardive movement disorders and metabolic syndrome effectively.2

Long-term antipsychotic adherence3,4 is essential to prevent any relapse and rehospitalization, both of which impair outcomes. Do not hesitate to use long-acting injectables (LAIs) from the first episode,5 advised Professor Glick.

 

Treat associated medical risk factors and diseases to close the 15-year mortality gap

Obesity, smoking and lack of exercise are common medical risk factors

The mortality gap for patients with schizophrenia is 15 years because many die prematurely due to inadequate treatment for type 2 diabetes and cardiovascular and smoking-related diseases.6 To recover these lost 15 years and have a normal lifespan, it is essential to target and treat:

  • associated medical risk factors, such as obesity, smoking and lack of exercise
  • diseases such as type 2 diabetes and cardiovascular disease7
  •  

Adopt a comprehensive, multidisciplinary, team-based treatment approach

Psychosocial interventions support and educate patients and their families and facilitate independent living and workplace functioning. Together with psychopharmacological and medical therapies and interventions, they are core components of the comprehensive, multidisciplinary, team-based treatment approach for psychosis, which improves both functional and clinical outcomes.8–10

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. Pillinger T, et al. Lancet Psychiatry 2019;7:64–77.
  2. Marder S, et al. N Engl J Med 2019;381:1753–61.
  3. Glick I, et al. Ann Intern Med 2001;134(1):47–60.
  4. Leucht S, et al. Am J Psych 2017 Oct 1;174(10):927–42.
  5. Kane JM, et al. J Med Econ 2013;16(7):917-25.
  6. Galletly CA. Lancet Psychiatry 2017;4:263–5.
  7. Firth J, et al. Lancet Psychiatry 2019;8:675–712.
  8. Glick I, et al. J Clin Psychopharmacol 2011;31(1):82–5.
  9. Dixon LB, et al. World Psychiatry 2016;15:13–20.
  10. Kane JM, et al. Am J Psych 2016;173(4):362–72.
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