Interview with Dr Zagozdzon on important management issues

Q. When you first tell a patient they have schizophrenia, do you tell them this is a lifelong condition?

A. We avoid using the term lifelong and usually postpones giving such information until asked or confronted. This is because, at the outset of managing a patient, it is unclear whether or not remission of psychosis is likely to be long-lasting or if the patient is at high risk of persistent symptoms.  The first visit is too early to make such a judgement, especially if there are problems with compliance.

Q. Having made a diagnosis of schizophrenia – do you tell patients at that point how long they are likely to need to be on medication?

A. Initially, the necessity for therapy is emphasised. Such therapy lasts 1 year or longer, depending on the course of the disease.

Q. What factors have a large contribution to the quality of life of a patient with schizophrenia?

A. The presence of psychotic symptoms impacts on a patient’s quality of life as do participating in social activities and being in paid employment.

Q. What methods do you employ to preserve or improve the quality of life of your patients with schizophrenia?

A. We take a holistic approach to patient management. We not only prescribe the most suitable therapy but we work with psychologists to get to know and understand our patients.

Q. Do you think of schizophrenia as a neurodevelopmental disorder or as a neurodegenerative disease?

A. Neither. Schizophrenia is a heterogeneous disease and looking at it from either perspective doesn’t help us as psychiatrists to choose the most appropriate therapies.  More needs to be known about the role that a history of trauma or genetics plays and we really don’t know how neurodevelopmental disorders are brought about.

Q. What proportion of patients with schizophrenia have the potential to achieve improvements in relationships?

A.  About 30% of patients can improve their relationships.