Life engagement is focus of patient-centered functional recovery

Enhancing patients’ engagement with life should be a key target when treating people with schizophrenia, Melissa Paulita Mariano (University of East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines) told a satellite symposium at CINP Virtual 2021.

The concept of “patient life engagement” encompasses life fulfillment, well-being, and participation in valued and meaningful activities.¹ It was developed as part of improved efforts to hear the voice of patients, and  to measure outcomes important to them .²

Ability to care for oneself and engage in family, social, work and recreational activities are valued goals

Life beyond symptoms

In a recent study of desired outcomes, people with schizophrenia gave their highest preference to symptom reduction, but this was closely followed by clarity of thought, reduced anxiety, and ability to care for oneself and engage in family, social, work and recreational activities. ³ Reduced fatigue and restlessness were among other factors mentioned.

Compared with the priorities of patients, healthcare professionals undervalue resumption of activities of daily living, improved satisfaction, and recovered capacity for work.⁴ As reflected in the 2021 American Psychiatric Association guidelines for patients with schizophrenia, optimal functioning and improved quality of life are now key treatment goals at all stages of their disorder.⁵

Enhancing patients’ engagement with life is a key target of treatment

Expanding treatment goals

Antipsychotics help control symptoms in schizophrenia, are effective in preventing relapse, and are recommended for long-term maintenance treatment.^5-10

But, as Christoph Correll (Charité Hospital, Berlin; and Donald and Barbara Zucker School of Medicine, New York) told the meeting, we must be aware that symptomatic remission does not equate to functional recovery: remitted patients do not necessarily have good function.¹¹ Symptomatic remission may be achieved in 70-80%, but social or functional recovery in only around 40%.¹¹

In a recent meta-analysis, all 32 antipsychotics included improved overall symptoms compared with placebo.¹² But not all of the 12 antipsychotics with relevant outcome data   outperformed placebo on measures of social functioning, an endpoint associated with recovery and social reintegration.

Professor Correll also noted that functioning may remain impaired even in patients with stable symptoms -- because of the impact of side effects, among which activating and sedating side effects are both prominent.¹³

With individualized treatment,  people with schizophrenia have the potential to achieve both long-term remission and functional recovery

Benefits beyond symptom control

Roger McIntyre (University of Toronto, Canada) further described the concept of “patient life engagement”. This encompasses outcomes reflecting life fulfillment, wellbeing, and participation in valued and meaningful activities.  ^14,15

He also showed how these elements, which go beyond the improvement of core symptoms, can be measured using a subscale which an expert group derived from the Positive and Negative Syndrome Scale (PANSS).^16,17

A post-hoc analysis of pooled data from three pivotal placebo-controlled trials of a D₂ receptor partial agonist suggested that active treatment brings greater patient life engagement.¹⁷ Response rates (defined as an improvement of 8 points or more from baseline) were significantly higher with active treatment than with placebo (44% vs 31.1%).

Moreover, response on the patient life engagement subscale was associated with improved functioning,¹⁷ Professor McIntyre reported.

Educational financial support for this satellite symposium at CINP Virtual 2021 was provided by Otsuka and H. Lundbeck A/S