Quality of life treatment goals

Dr Kane spoke on current treatment options at a satellite symposium on functioning and quality of life (QoL) as long-term treatment goals in schizophrenia. Afterwards, our correspondent spoke with him to hear more of his views on current treatments and patient outcomes. 

To what extent do you think psychiatrists need to increase their focus on improving functioning and QoL of their patients with schizophrenia when making treatment decisions?

Psychiatrists need to increase their focus on these important aspects of the disease. Until now, their attention has mainly been directed towards managing the key signs and symptoms of schizophrenia. However, for patients and their families, a good QoL, functioning and leading a normal life are extremely important. By ‘normal life’ I mean patients being engaged in the community, having relationships, and being able to go to work or school – patients need help in achieving these goals. They need to be taking the best medicine for them, to be helped to continue taking it, and to be offered psychosocial interventions to support them in this process.

When you think about your patients, what do they experience as improvements in functioning and QoL? What matters to them and how do they talk about it during consultations?

The things that are most important to patients are social relationships, having a job, a place to live, an intimate relationship, and hobbies. Like any person, patients want to feel connected to others, that they belong in their families and communities, and that they are living their life in a meaningful way – this is what anyone would want.

With the therapeutic options at disposal today, what do ‘outcomes’ for people with schizophrenia look like?

Outcomes currently leave a lot to be desired. Only about 14% of patients with schizophrenia achieve what we would call a recovery and are able to achieve all the sorts of goals we have been talking about above. A primary driver for the clinician is to address the symptoms that first brought the patient into the healthcare system, for example, agitation and aggression. These are obviously symptoms to manage, but treatment strategies for these acute problems are not necessarily the most useful for long-term overall management of the patient’s condition. Moreover, in the community patients are often not getting all the help they need to improve their functioning and QoL. Physicians are trained to help solve medical problems, but they also need to work with colleagues to ensure that their patients get access to and benefit from psychosocial interventions. These are often needed to help manage the patient’s physical health and well being, their lifestyle, avoid substance abuse, stop smoking etc. Otherwise schizophrenia takes a large toll on patients: chronic and severe mental health issues can reduce a patient’s life expectancy by 15 years.

In your opinion, what role can newer generation aLAIs play in improving the outcomes for people with schizophrenia, and why?

The importance of medication in managing schizophrenia has been demonstrated beyond doubt. However, understandably, people do have problems taking oral medication in the long-term. So long-acting drugs offer the option for patients to receive their treatment at less frequent intervals, which also allows us to maintain contact with the patient, and undertake other psychosocial interventions over a long period of time.

If there were three pieces of advice you would give your fellow psychiatrists around getting the most out of an aLAI as a treatment option, what would they be?

Use it, use it and use it! These drugs are currently under-utilised. So work with patients; spend the time to understand why they may be reluctant to try these treatments, and work out how to present this treatment option to the patient in a way that will appeal to them. Working with patients in using LAIs is a process that takes time, so don’t give up too quickly. If the psychiatrist and the patient work together within a good therapeutic alliance, they can both take steps to prevent relapses and optimise the patient’s long-term outcomes.