Schizophrenia Meeting Identifies Key Factors
in Improving Long-Term Patient Outcomes and Care
Patient Education, Physician Education and Updated Antipsychotics
Top the List of Measureable Improvements
Copenhagen, November 5, 2010: A 2-day international meeting of over 600 psychiatrists from Europe, the Middle East, and Africa (in addition to other areas), held in Copenhagen from October 29–30, revealed significant findings from studies in the care and treatment of patients with schizophrenia. Meeting presentations suggested actionable recommendations for physicians, caregivers and patients which can produce measureable and improved patient outcomes.
The meeting was titled: ‘Current and future treatment options in psychosis: how can we meet our patient’s clinical needs?’
Framing the Challenge – Schizophrenia is a severe disorder associated with a significant impact on quality of life, a high level of patient disability and a considerable social and economic burden.1 While hospitalization and long-term care accounts for 1.5–3% of national healthcare budgets, the indirect costs of the disease (lost work productivity, institutional and social care, mortality and homelessness) increase those costs to up to 5–10% of national healthcare budgets.2,3
Many of the presenters highlighted that one of the single largest obstacles to improving long-term outcomes for patients with schizophrenia is medication adherence (defined as the degree to which a patient takes their medication as prescribed). On average, only 50% of patients with a chronic disease of any type adhere to their medication as prescribed.4 In patients with schizophrenia the rate of non-adherence may be even higher; without intervention, 50% of patients with schizophrenia stop taking their medication within 12 months, and 75% of patients are likely to discontinue medication within 24 months.5
Partial or non-adherence to medication has a considerable negative impact on patient outcomes and on the course of their schizophrenia. Of note, patients who are non-adherent or are only partially adherent to their medication are almost five times more likely to relapse than those who are adherent. Patient relapse is associated with considerable financial and emotional burden.6,7Additionally, with each relapse, recovery is hindered and the course of the illness deteriorates.8,9
Promising Pointers for the Future – The meeting consensus was that tackling the challenge of medication adherence in patients with schizophrenia can bring about the biggest results in improving patient quality of life, reducing the burden of caregivers, and the cost of care. Several innovative solutions were presented, along with study data.
Educating patient and caregivers was identified an important aspect for improvement. One study showed that the level of family and social support, as well as early medication acceptance, was strongly correlated with successful adherence.10 Another study demonstrated that educating the patient about the condition itself improved adherence. Information transfer however did not suffice. The education that mattered most was a) helping to change the patient attitude more positively toward medication in general, b) helping the patient with coping and adaptive skills and behaviours11 and, c) connecting positive outcomes for the patient with medication adherence.12
A second aspect critical to patient outcomes is continuing professional education for physicians and staff. Interestingly, a study of healthcare staff revealed similar attitudes towards medication adherence as patients, suggesting that healthcare staff themselves would be no more adherent to medication than their patients.13 Presentations recommended that healthcare staff, and thus their patients, would benefit from continuing education in select areas: new methods of emphasizing medication adherence to patients, positive reframing of non-adherence with patients, teaching patients coping and adaptive skills, and offering treatment options and choices to patients and caregivers as effective means of improving adherence.
In addition to education, second-generation antipsychotic (SGA) drugs are associated with a positive effect on medication adherence. Long-acting injectable (LAI) antipsychotic formulations do not need to be taken as frequently as oral antipsychotics, thereby removing the burden of daily medication and enhancing convenience for the patient.
Treatment with SGA LAIs results in significant efficacy benefits compared to oral antipsychotic treatments. Relapse rates fell from 50% for oral medication to less than 20% for LAIs over a 1-year period, and from a relapse rate of 75% for oral medication to just over 20% for LAI antipsychotic medications over a two-year period in a prospective, naturalistic, controlled study.14 Hospitalization rates also significantly declined with SGA LAIs, and additional benefits were observed in another observational study.15
Presentations during the second day of the meeting focused on the relevance of specific treatment goals as well as some of the remaining unmet needs in the treatment of patients with schizophrenia. The impact of current oral antipsychotics on patient outcomes and research aimed at identifying new therapeutic targets for schizophrenia were also described.
Cognitive deficits are one of the core features of schizophrenia. Data were presented indicating that subtle impairments in cognitive performance are already present during early adolescence and can be detectable even before the onset of psychosis.16 Evidence showed that cognitive performance has a strong bearing on interpersonal relations, psychosocial functioning and professional reintegration.17 However, the outcomes from naturalistic, open, randomized trials suggest that significant and persistent improvements in cognitive performance in patients with schizophrenia has not so far been achieved with the available treatments.18
The increasing importance of patient functioning as a measure of treatment success was also covered19 with much effort focused on the development of a validated scale with which it can be assessed. For example, the Personal and Social Performance (PSP) scale was cited as being useful in objective measurement of patient functioning. The scale was developed in 2000 by Morosini et al,20 to assess patient functioning in four domains of behaviour: socially useful activities, personal and social relationships, self-care, and reduction of aggressive and disturbing behaviours.
One presentation highlighted the improvement in patient functioning (based on PSP scale score) following treatment with an oral extended-release SGA.21 Furthermore, with the use of newer oral extended release formulations patients themselves reported greater satisfaction with the drug,21 which can be a large factor in medication adherence, as stated previously.
Pharmacotherapy thus serves as a good basis for potential improvements in patients, which can be further enhanced by concurrent patient training and cognitive therapy, family intervention therapy and vocational rehabilitation.19 Treatment goals have thus evolved from a focus on symptom control through medication to improved functioning and recovery on a broader set of measures.22
The final presentation illustrated the emerging neural mechanisms identified through genetic imaging that have been associated with brain abnormalities in schizophrenia,23 and how these discoveries may complement the current advances in psychosocial and pharmacological treatments.
The key future action arising from this meeting is the importance of continuing to support physician education. The healthcare provider is at the forefront of both patient education and use of improved second-generation antipsychotics. The meeting organizers will be strategizing medical education activities for healthcare professionals during the remainder of 2010, to bring about improvements in patient outcomes through identifiable, evidence-based continuing education programmes in 2011.
This 2-day medical education meeting was approved for Continuing Medical Education (CME) credits by the European Accreditation Committee in CNS (EACIC), and was funded by a grant from Janssen Pharmaceutica, NV, who specialize in innovative treatments and support patients living with mental illness and the people who care for them.
Janssen Pharmaceutical Companies of Johnson & Johnson are dedicated to addressing and solving the most important unmet medical needs of our time, including oncology (eg multiple myeloma and prostate cancer), immunology (eg psoriasis), neuroscience (eg schizophrenia, dementia and pain), infectious disease (eg HIV/AIDS, hepatitis C and tuberculosis), and cardiovascular and metabolic diseases (eg diabetes). Driven by our commitment to patients, we develop sustainable, integrated healthcare solutions by working side-by-side with healthcare stakeholders, based on partnerships of trust and transparency. More information can be found at http://www.janssen-emea.com/.
About Janssen Medical Education in Psychiatry
Through its website, the Psychiatry Medical Education Portal (www.PsyAcademy.com), Janssen strengthens its partnerships with healthcare professionals within the mental health community. The website, regularly updated with new content, contains a host of medical education materials and includes presentation slide decks from recent meetings, CME accredited webcasts and various educational tools that can be utilized by healthcare professionals in every clinical day practice.
About San Lucas Medical
San Lucas Medical (www.sanlucasmedical.com) is a publisher of premier medical publications in Europe and Asia. Located in London, United Kingdom, San Lucas publishes magazines in the medical specialties of mind and brain, oncology, haematology, neurology, dermatology, cardiology, and numerous other subjects. San Lucas representatives attended this meeting in Copenhagen to report on its presentations and outcomes. San Lucas Medical is also the primary funding agent for MDSNe, the European online social network for medical doctors. www.mdsne.com
Contact: Dayan Gunesekera, San Lucas Medical
Email: [email protected]
Phone: 44-(0)7957 441160
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