Linda Trinh, DNP, MPH, FNP-C, PMHNP-BC

Panelists discuss how best practices involve starting with lower doses in older patients, considering long-term tolerability over acute symptom control, and potentially using xanomeline/trospium chloride as first-line treatment even for treatment-naive patients presenting with acute psychosis.

Panelists discuss how Lila’s late-onset schizophrenia at age 52 raises diagnostic concerns requiring thorough medical workup, and how her response to olanzapine with sedation and shakiness suggests the need for dose reduction or consideration of alternative treatments such as xanomeline/trospium chloride.

Panelists discuss how xanomeline/trospium chloride should be positioned as a first-line treatment option rather than waiting for treatment failures, given its superior effect size, comprehensive symptom coverage, and favorable tolerability profile compared with that of traditional antipsychotics.

Panelists discuss how switching patients to xanomeline/trospium chloride requires different cross-titration strategies depending on whether patients are on “done” medications versus “pines” medications, with special attention to anticholinergic effects when transitioning from sedating antipsychotics.

Panelists discuss how real-world experience with xanomeline/trospium chloride shows efficacy across all 3 symptom domains with manageable gastrointestinal adverse effects that typically resolve within 2 weeks, requiring slow titration and patient education about empty stomach dosing.

Panelists discuss how xanomeline/trospium chloride represents a first-in-class medication with a novel muscarinic mechanism that addresses positive, negative, and cognitive symptoms while avoiding typical antipsychotic adverse effects such as movement disorders and prolactin elevation.

Panelists discuss how Jacob’s case demonstrates the importance of recognizing negative symptoms that preceded positive symptoms by nearly a year, and how a partial response to risperidone with continued breakthrough symptoms and cognitive “fogginess” indicates the need for treatment optimization.

Panelists discuss how clinicians can better identify subtle and unreported schizophrenia symptoms through systematic evaluation of positive symptoms, negative symptoms, cognitive deficits, and functional impairment, which often requires input from family members and caregivers.