Outlining the Key Challenges in Schizophrenia Management

Welcome back to another Psychiatric Times peer exchange series. In this opening episode, moderator Dr. Gus Alva convenes a multidisciplinary panel of psychiatric experts — including Dr. Hara Oyedeji, Mark Jankelow, Dr. Christoph Correll, and Dr. John Kane — to examine the evolving landscape of schizophrenia treatment. The panel frames the central challenge of the series with a pointed question: what clinicians do when the medication a patient will actually take is not necessarily the one they need most.

Dr. Kane opens the clinical discussion by emphasizing that every patient presents uniquely, requiring clinicians to thoroughly understand each individual's personal history, beliefs, and attitudes toward their illness. He highlights the difficulty of engaging patients — particularly young people — in long-term treatment given that schizophrenia is a chronic condition, and underscores the importance of addressing social determinants of health, leveraging family support systems, and screening for complicating factors such as substance use.

Mark Jankelow builds on these themes by sharing an illustrative case from his 18 years of practice: a young man whose paranoid delusion that food was poisoned had caused dangerous weight loss and profound lack of insight. Mark describes how building trust through the patient's mother proved pivotal, ultimately enabling a successful medication transition to cariprazine and sustained recovery over 11 years — with no further psychotic episodes. Dr. Alva closes the segment by noting how anosognosia, or lack of illness awareness, represents one of the most significant barriers to treatment engagement in schizophrenia.

In the next episode, "The Clinical and Economic Burden of Poorly Managed Schizophrenia," panelists continue their discussion on schizophrenia and highlight the wide-ranging personal, societal, and economic consequences of inadequate treatment, emphasizing how relapse prevention and investment in direct care can reduce the far greater indirect costs borne by patients, caregivers, and society.