Comprehensive treatment of all schizophrenia symptoms is possible and many people with schizophrenia can now recover in ways not previously thought possible, according to the panel of nationally recognized psychiatrists and psychologists whose discussions and recommendations are published in a supplement to the current issues of Primary Psychiatry and CNS Spectrums (CNS Spectr. 2005;10(2 Suppl 1):1-16). A copy of the supplement can also be accessed at http://www.mblcommunications.com/proceedings.php3.
"Traditionally, physicians have been oriented to treating schizophrenia by preventing symptoms from getting worse, rather than helping the person continue to get better beyond their current level of symptoms and functioning," said Peter J. Weiden, MD, professor of psychiatry and director of the Schizophrenia Research Service at State University of New York (SUNY) Downstate Medical Center in Brooklyn, an author of the statement. "But we now know that by taking a long-term focus and tackling a broader range of symptoms, many patients do steadily improve so that they can function better, and live fuller, more complete lives."
While medications to treat schizophrenia's positive symptoms (such as hallucinations, delusions, and disorganization) have existed since the mid-20th century, newer medications introduced in the early 1990s, known as atypical antipsychotics, also control the often overlooked symptoms of depression, suicidal thoughts, and problems remembering or concentrating (affective and cognitive symptoms). Yet "dealing with affective and cognitive impairment has not yet become prominent on the clinical horizon," according to Nina R. Schooler, PhD, adjunct professor of psychiatry at Georgetown University School of Medicine, an author of the statement.
The supplement and consensus statement were developed to encourage physicians to address the debilitating effects of depression, cognitive impairment and other aspects of the disease that dramatically impact the quality of life for people with schizophrenia," said David L. Ginsberg, MD, director of Outpatient Services, Tisch Hospital Department of Psychiatry at New York University Medical Center and section editor of MBL Communications, Inc., publishers of Primary Psychiatry and CNS Spectrums.
The supplement, entitled Optimizing Treatment of Schizophrenia: Enhancing Affective/Cognitive and Depressive Functioning, includes a discussion of the results of a new Harris Interactive® national consumer survey of people with schizophrenia, which clearly illustrates the problem:
"Failure to control the affective and cognitive disease symptoms is one of the biggest barriers preventing many patients today from achieving a meaningful social and occupational recovery," said Philip D. Harvey, PhD, professor of psychiatry at Mount Sinai School of Medicine and chief psychologist at Mount Sinai Hospital, an author of the statement. "We believe it is important for doctors to look beyond the control of positive symptoms and consider the affective/cognitive benefits of medication to help patients achieve a 'functional' recovery."
Studies suggest that atypical antipsychotics improve cognition better than older antipsychotics, but even atypical antipsychotics differ in their ability to treat these symptoms. In a large-scale study, patients who had not responded well to prior treatment with risperidone, olanzapine, or conventional antipsychotics were switched to ziprasidone, one of the newer atypical antipsychotics, and showed statistically significant improvement in cognitive symptoms.
Not only do atypical antipsychotics differ in their ability to improve cognition, they have different side effect profiles. Weight gain in particular has become a problem with some medications. The survey shows that more than 75 percent of patients on antipsychotic medications gain weight and of those who said they gained weight, the average weight gain is 52 pounds. Fortunately, at least two of the newer medications are not associated with weight gain. The authors advise that factors such as side effect profiles are predictable and individual preferences should be considered.
People with schizophrenia agree with the optimistic views expressed in the consensus statement. The survey found that virtually everyone with schizophrenia (94%) believes that daily functioning is part of successful treatment for schizophrenia and most (83%) believe with the right medications, people with schizophrenia should be able to lead full lives.
In addition to Drs. Weiden, Schooler and Harvey, Peter F. Buckley, MD, professor and chairman of the Department of Psychiatry and Behavioral Health at the Medical College of Georgia, is also an author of the statement.
Schizophrenia is a seriously debilitating mental illness characterized by distortions of reality and disturbances in perception, mood, cognition, motivation, social function and motor behavior. Schizophrenia affects approximately one in every 100 people. The cause of schizophrenia is unknown, but it is believed to be the result of abnormal brain functioning. Schizophrenia is associated with changes in cognition that affect the ability to remember and to plan for achieving goals. In addition, interest and motivation are diminished and many individuals become depressed and socially withdrawn. The affective and cognitive problems associated with schizophrenia may be important factors in long-term outcome.
About the Survey
Harris Interactive® conducted the "Optimizing Treatment in Schizophrenia Survey" online from October 27 – November 15, 2004, among 139 U.S. adults 18+ who have been diagnosed with schizophrenia, who have switched schizophrenia medications at least once and who were members of the Harris Interactive Chronic Illness Panel. No weighting was applied to these results, which have a sampling error of ±10 percentage points. Source of survey: "Optimizing Treatment in Schizophrenia Survey, November 2004."
About MBL Communications
MBL Communications, Inc. is the independent publisher of the monthly journals Primary Psychiatry and CNS Spectrums, as well as a host of enduring material programs in conjunction with Mount Sinai School of Medicine. Primary Psychiatry – The Leading Voice of Clinical Psychiatric Medicine – is the largest circulation, peer-reviewed psychiatric journal in the United States, with a monthly circulation of over 65,000 primary care physicians and psychiatrists. Primary Psychiatry addresses the significant comorbid interface between psychiatry and primary care medicine. CNS Spectrums – The International Journal of Neuropsychiatric Medicine – is a monthly Index Medicus/MEDLINE journal designed to bridge the clinical information needs of 48,000 US-based psychiatrists and neurologists. If you would like to learn more about MBL Communications, Inc. please visit: www.mblcommunications.com.
The Optimizing Treatment of Schizophrenia: Enhancing Affective/Cognitive and Depressive Functioning supplement and survey are sponsored by Pfizer Inc and coordinated by Chandler Chicco Agency.