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Life engagement is focus of patient-centered functional recovery
Enhancing engagement with life is a key target of treatment in schizophrenia and extends beyond symptom control. “Patient Life Engagement” encompasses outcomes that reflect life fulfillment, well-being, and participation in valued and meaningful activities and can be measured using a subscale based on the PANSS that captures the beneficial effects of antipsychotic D2 partial agonist therapy.
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
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. McCue et al. Neurol Ther 2019;8(2):167-76
2. Ismail et al. Poster at SIRS 2020 [M191]
3. Bridges et al. Patient Prefer Adherence 2018;12:63–70
4. Bridges et al. Health Expect 2013;16(2):164–176
5. APA. Practice guideline for the treatment of patients with schizophrenia, 3rd edition, 2021
6. Leucht et al. Am J Psychiatry 2017;174(10):927–942
7. Huhn et al. Lancet 2019;394(10202):939–951
8. Citrome. Patient Prefer Adherence 2016;10:1529–1537
9. NICE. Psychosis and schizophrenia in adults; treatment and management, NCG178, 2014
10. CINP. Schizophrenia guideline, 2013
11. Zipursky et al. Schizophr Bull 2013;39(6):1363–1372
12. Huhn et al. Lancet 2019;394(10202):939–951
13. Tandon et al. Ann Gen Psychiatry 2020;19(42)
14. Weiss et al. Poster at Psych Congress 2019 [221]
15. Bartrés-Faz et al. Alzheimers Res Ther 2018;10(1):47
16. Ismail et al. Poster at SIRS 2020 [M191]
17. Meehan et al. Poster at ASCP 2020