Highlights from the 36th European College of Neuropsychopharmacology – ECNP – Congress

Enhancing brain health

A variety of brain disorders were discussed at the 36th ECNP Congress, ranging from bipolar disorder to major depressive disorder (MDD) to schizophrenia. The burden presented by the unmet needs of these disorders on both the patient and the healthcare system were showcased at multiple sessions. One such session highlighted that many patients with MDD still report sub-optimal health outcomes, including poor health-related quality of life and overall functioning, despite antidepressant treatment.^3-5 The impact depressive disorders have on brain health can lead to physical comorbidities as well, with a 64% higher risk of developing coronary artery disease than people without depression.⁶

Adults with a depressive disorder have a 64% higher risk of developing coronary artery disease⁶

In response, there seems to be an ongoing effort in recent years to build a more complex picture of MDD, as a collection of afflictions rather than a singular condition. By identifying and targeting specific dimensions in MDD, such as cognition, emotional blunting and anhedonia, it may lead to improved patient-reported outcomes that could result in a full functional recovery.^7-10

Promoting better treatment

Treatment of other brain disorders, such as schizophrenia, are already well established. However, despite the number of antipsychotic medication options available, management of cognitive and negative symptoms is a largely unmet clinical need in schizophrenia. Currently available antipsychotics provide only modest benefit in managing these symptoms, even though they often have the most impact on patients’ daily lives.¹¹ Despite this, antipsychotics have still been shown to play a crucial role in the prevention of relapse through maintenance treatment, but with more than 50% of patients not adhering to their initial prescription after hospitalization, the approach to schizophrenia management may need to be reevaluated.¹²

More than 50% of patients with schizophrenia do not adhere to their initial antipsychotic prescription after hospitalization¹²

Various sessions at the 36^th ECNP congress looked at the potential for improving schizophrenia treatment. The principles of shared decision-making and motivational interviewing were highlighted as powerful tools in engaging patients and improving adherence.¹³ By recognizing the significance of patient preferences and incorporating them into treatment plans, psychiatrists may be able to enhance the overall quality of care for individuals living with schizophrenia and reduce the devastating impact of relapse on their lives.^13,14

With patient preference in mind, the benefits of certain antipsychotic agents were evaluated, and it was shown that in one study, long-acting injectable antipsychotics (LAIs) were found to be preferred by 77% of patients when compared to oral agents.¹⁴ This could be why LAIs offer the chance for better adherence and lower relapse, rehospitalization and mortality.^15,16

In a study, long-acting injectable antipsychotics were preferred by 77% of patients when compared to oral agents for the treatment of schizophrenia¹⁴

Advancing the science of the brain

It was not only current treatment options that were debated at this annual congress, but also the future of treatment in the form of potential new agents. Though our understanding of schizophrenia has evolved, current pharmacological treatments all operate using the same mechanism – blockade of the dopamine D₂ receptor – and have done for over 70 years. Novel treatment targets may be of particular benefit in symptom domains which were not well served by existing medications.¹⁷

Muscarinic acetylcholine receptors (mAChR) are promising targets for drug intervention in various brain disorders due to their involvement in the regulation of complex behaviours, such as cognition, movement, and reward.¹⁸ In particular, targeting the M₁ receptor may enhance cognition and reverse memory deficits in schizophrenia, and as a result, several modulators for M₁ have entered clinical trials.¹⁸

Targeting the M₁ receptor may enhance cognition and reverse memory deficits in schizophrenia¹⁸

TAAR1 is another receptor target with therapeutic potential, with agonists currently in clinical development. In preclinical models, it has been shown to modulate neurotransmitters important to schizophrenia, including dopamine, serotonin and glutamate, and may provide a unique way to modulate hyperdopaminergic states without receptor blockers.¹⁹

The congress ended on October 10 with the last of its 80 unique sessions, after having successfully facilitated the communication of ideas, discoveries and best practices to all participants. In light of the prospective emergence of novel treatment targets, anticipation for the next ECNP congress in Milan is bound to be high.