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The importance of patient functioning in schizophrenia

Speakers at this satellite symposium discussed the importance of addressing not just the symptoms of schizophrenia, but all aspects of the disorder that have an impact on patient’s functioning.

Moving towards recovery

The goals of treatment were discussed by both Prof Peter Falkai, Germany, and Dr Andrea Fagolini, Italy. When pharmacological treatment was first available, the focus was first on response, that is, symptom control and relapse prevention, then on remission – ensuring that patients had fewer and less severe symptoms over time. However, those patients who showed symptomatic remission did not necessarily show good outcomes in their daily life, so the focus moved to recovery, and an emphasis on patient functioning. In this context, recovery means the attainment of a functional and valued life, rather than simply the absence of symptoms.

Recovery means the attainment of a functional and valued life, rather than simply the absence of symptoms

This implies treating the symptoms of psychosis, but also addressing other aspects of the disorder that have an impact on people’s needs in their lives (for instance, work skills, interpersonal relationships and everyday life activities). In this way, patients can reach a stage where they have optimal functioning, and can cope with their illness in the long term.

It also requires that patients’ physical as well as mental health are attended to, because many patients with schizophrenia are also burdened with physical ill health, such as cardiovascular risk factors and disease1. It is therefore important to treat all the symptoms a patient is experiencing and maintain their general well-being to promote their long-term quality of life.

Balance in treatment

Treating people with schizophrenia today is no longer a question of response or remission – what we want to achieve is recovery

Prof Christoph Correll, Germany discussed the need to find a balance between achieving symptom control and preventing relapses, while also minimizing adverse events and comorbidities, and promoting adherence, good physical health, functioning and quality of life2.

Negative symptoms are relevant predictors of real-world behavior in schizophrenia3. They affect patients’ ability to engage with others, to work and to take part in community activities. So, it is important that these are treated as effectively as possible.

Tolerability of drugs is the bridge between efficacy and adherence. Moreover, good adherence is essential to achieve patient outcomes, such as subjective well-being, quality of life and functional capacity. Pharmacotherapy also needs to be supported by effective psychotherapy and psychoeducational interventions4.

In this way, through multidisciplinary interventions, good patient outcomes can be achieved in the long term. Treating people with schizophrenia today is no longer a question of response or remission – what we want to achieve is recovery

Educational financial support for this Satellite symposium was provided by Gedeon Richter and Recordati S.P.A.

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. Correll CU. CNS Spectr 2007;12(10 Suppl 17):12–20.
  2. Correll CU. Nervearzt 2020;91:34–42.
  3. Bowie C, et al. Biol Psychiatry 2008; 63:505–11.
  4. Correll CU. J Clin Psychiat 2011;72(Suppl 1):9–13.
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