Optimizing therapy in schizophrenia — addressing cognition, function, and cardiovascular disease risk factors

Future clinical trials should focus on cognitive and functional assessments as well to evaluate therapeutic efficacy

In addition to treating psychotic symptoms effectively with optimal safety and tolerability to encourage long-term adherence, the goals of treatment for patients with schizophrenia should also include:

• achieving a functional recovery with good occupational, educational, social, and personal functional outcomes, resulting in independence and a good quality of life
• optimizing physical health by addressing risk factors for CVD and metabolic diseases, which are more prevalent among people with schizophrenia than in the general population and result in premature mortality

Neurocognitive outcome impacts functional outcomes

Processing speed is the most severely affected cognitive function in schizophrenia

Cognitive, social cognitive, and negative symptoms, functional capacity, motivation and engagement are all predictors of everyday disability in schizophrenia, said Philip Harvey, Professor of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, USA. Many cognitive domains are impaired, but processing speed is most severely affected.

Cognitive, social cognitive, and negative symptoms, functional capacity, motivation and engagement are all predictors of everyday disability in schizophrenia

Professor Harvey proposed that future clinical trials should also focus on cognitive and functional assessments while evaluating therapeutic efficacy.

All cognitive domains and social cognition can be assessed using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB), he said.

However, this test takes 75 minutes to administer and score. Shorter assessments include the Brief Assessment of Cognition in Schizophrenia (BACS), which takes 30 minutes, and a variety of new iPad tools are also available.

Functional capacity can be measured using the UCSD Performance-based Skills Assessement (UPSA), which has a 100-point score.

Cardiovascular disease shortens life expectancy

Clinicians can help to lower patient risk of cardiovascular disease

Patients with schizophrenia die prematurely, mainly due to CVD, said Christoph Correll, Professor of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA, and Professor of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.

Untreated patients with schizophrenia are more likely to die from CVD than those who are treated; and Professor Correll postulated that this is because untreated patients are not monitored, so their CVD risk factors remain unidentified and untreated.

Professor Correll highlighted that physical inactivity, smoking, obesity and poor nutrition are all more common among people with schizophrenia than in the general population, and that these CVD risk factors are compounded by:

• reduced access to and use of high-quality medical care
• weight gain, blood glucose and lipid abnormalities, and metabolic syndrome, resulting from the use of some types of antipsychotics — these side effects also reduce quality of life and adherence

Professor Correll suggested that clinicians can lower patient risk of CVD by regular CVD and risk monitoring, judicious use of antipsychotics, and advising on behavioral modifications.

This Satellite Symposium was sponsored by Sunovion / Sumitomo Dainippon Pharma