Schizophrenia - Treatment Principles

When selecting treatments for schizophrenia, physicians have to consider many variables, including the patient’s health and lifestyle, co-prescribed medications and previously experienced adverse events. This slide deck covers the progression of schizophrenia and functional decline. You will gain insight into treatment principles, the impact of adverse events on patients and the importance of early intervention for patients with schizophrenia.

This slide deck has been developed in collaboration with the former Lundbeck International Neuroscience Foundation.

file_download Download slide file_downloadDownload all

Index for
slide deck

Title

Treatment principles

In most patients the formal onset of Schizophrenia is preceded by a period of symptoms, known as the prodromal period.^{[Lieberman et al., 2001]} Symptoms in this stage can include mood disturbances and cognitive symptoms.^{[Lieberman et al., 2001; McGlashan, 1996]} Treatment…

file_download Download slide

Treatment principles

file_download Download slide

The progression of schizophrenia and functional decline

In most patients, the formal onset of schizophrenia is preceded by a period of symptoms, known as the prodromal period.^{[Lieberman et al., 2001]} Symptoms in this stage can include mood disturbances and cognitive symptoms, as well as positive symptoms.^{[Lieberman et…}

file_download Download slide

Schizophrenia – Treatment-Principles – slide 4

Treatment should be optimised for each individual in order to improve the outcome

Key message: Treatment outcomes can be optimised for an individual by skilful utilisation and coordination of pharmacological, psychosocial, and educational resources.

Background

A clinically effective treatment is characterised by:^{[Tandon et al., 2006]}

long-term reduction in symptoms of disease, treatment…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 5

Psychosocial interventions should be tailored to the goals, needs, abilities and circumstances of patients

Key message: Psychosocial interventions should be tailored to the carefully assessed goals, needs, abilities, and circumstances of individuals rather than assuming a ‘one size fits all’ approach.

Background

Psychosocial interventions work synergistically with medication to optimise treatment adherence and…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 6

Disease phases in schizophrenia

The slide summarises the main phases of schizophrenia, and the frequency of patients transitioning between phases based on a wide-ranging literature review.^{[Carbon & Correll, 2014]} After reviewing the literature, the authors conclude that a key problem in understanding the course…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 7

Different phases of schizophrenia have different treatment goals

According to the American Psychiatric Association guidelines on the treatment of schizophrenia, the goals of treatment are adapted to the stage of the illness.^{[Lehman et al., 2010]}

Acute phase The goals of treatment during the acute phase of a…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 8

Factors to consider when setting treatment goals

Because schizophrenia is a chronic illness that influences virtually all aspects of life of the affected persons, treatment planning has three goals:^{[Lehman et al., 2010]}

reduce or eliminate symptoms
maximise quality of life and adaptive functioning
promote and maintain…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 9

The importance of relapse prevention

As shown on the slide, there are many functional consequences of relapse, including long-term disability, an increased risk of suicide, decline in cognitive function, and decreased quality of life.^{[Ascher-Svanum et al., 2010; Birchwood et al., 2000; Briggs et al., 2008;…}

file_download Download slide

Schizophrenia – Treatment-Principles – slide 10

Antipsychotic therapy significantly reduces relapse rates

A systematic review and meta-analysis, published in 2012, identified 116 reports from 65 trials of antipsychotic therapy in patients with schizophrenia.^{[Leucht et al., 2012]} This information amounted to data for 6,493 patients.^{[Leucht et al., 2012]} The results demonstrated that maintenance…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 11

Continuous maintenance treatment may decrease deterioration in symptoms during the second year following diagnosis

Key message: Continuous maintenance treatment is more effective than targeted intermittent treatment in preventing relapse.

Background

This randomised controlled trial investigated the impact of continuous maintenance treatment versus targeted intermittent treatment after stepwise discontinuation in the second year following…

file_download Download slide

Schizophrenia – Treatment-Principles – slide 12

Only a small proportion of patients with schizophrenia achieve recovery

Key message: Some patients with schizophrenia may achieve recovery with effective treatment. Social functioning, medication adherence, and type of antipsychotic, are important predictors of recovery.

Background

In a 3-year observational study of adults with schizophrenia (n=6,642), the frequency and predictors…

file_download Download slide