Optimizing Management of Schizophrenia with LAIs - Episode 3

Schizophrenia Relapses and Patient Well-Being

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Transcript: Erin C. Crown, PA-C: Schizophrenia is a chronic illness. Patients usually experience their first psychotic break in their mid-teens or early adult years. We’re still seeing them in clinics, and unfortunately sometimes in inpatient settings, in their 40s, 50s, and 60s. There are decades of time of needing to prevent or reduce the risk of relapse. Over time, as Sanjai said, we see cognitive decline with each relapse. Oftentimes we never see them recover to their original baseline.

With each subsequent relapse, they don't get fully back to where they were prior to that relapse. I've worked in both the inpatient and outpatient setting. I'm presently in an outpatient clinic, and I often see a reduced support structure over time. When I'm seeing people with schizophrenia in their 40s, 50s, and 60s, they're often coming to visits with their case managers, not with a family member. They often don't have relationships with family members or other outside social, friendly supports with whom to talk. The professional team has become their support network: case managers, therapists, prescribers, and maybe a peer support specialist. Homelessness often results over time, substance use, substance abuse, incarceration, and poor physical health.

We began to see metabolic illnesses, high cholesterol, and high blood pressure. When they aren’t taking care of themselves, these physical health issues worsen, causing further cost to the health care system. We see diminished response to medications over time. These are all reasons why it's important to reduce the risk of relapse and delay time to relapse, to help preserve as much of that baseline function as we can, and to keep family and social supports intact. The goal is for them to be functioning, positively contributing members of society, over the long term.

John M. Kane, MD: These important points emphasize how critical it is to prevent relapses early in the course of the illness. When we think about someone who is young and has recently experienced the onset of schizophrenia, just 1 or 2 relapses can result in the erosion of a lot of life’s opportunities. The things that we take for granted, like work, school, and friends.

It emphasizes how critical it is to try to prevent as many relapses as we can. Nonadherence is a major contributor to relapse. Dawn, what are your thoughts about this issue, what factors influence treatment adherence, how do you monitor it, and how can you increase adherence in patients?

Transcript Edited for Clarity