Overview of Schizophrenia and Its Impact on Patients and Families

DR. ALVA: Hello, and welcome to this Psychiatric Times Expert Perspectives video series. I’m Dr. Gus Alva, Medical Director of ATP Clinical Research in Costa Mesa, California, and I am joined by Desiree Matthews, PMHNP, owner and Clinical Director at Different MHP.

Today we will be discussing schizophrenia and the inherent challenges with managing this complex and chronic brain disorder, including treatment nonadherence and delaying relapse. In my opinion, there are so many appropriate adult patients that may benefit from these treatments but may not even be aware that there is an option without your help to educate them. The conversation will then pivot to long-acting injectables, or LAIs–such as once-monthly INVEGA SUSTENNA® (or paliperidone palmitate), which is part of the Johnson & Johnson LAI portfolio that includes pathway options to 3 and 6 months.

We will then review comparative safety and efficacy data on INVEGA SUSTENNA® compared to orals and discuss ways by which J&J LAIs may help address challenges of managing schizophrenia.

MATTHEWS: Thank you for that introduction, Dr. Alva, and hello, everyone. Happy to be speaking with you today. Before we get started, I’d like to note that this program is sponsored by Johnson & Johnson. Now, let’s get started.

DR. ALVA: We’ll begin with a general overview of schizophrenia. Desiree, can you describe the overall nature of the condition and how it affects adult patients?

MATTHEWS: Absolutely. I’ll start by saying that schizophrenia affects millions of adults in the U.S., and it is associated with a substantial burden to the healthcare system. It is one of the top 20 reasons for disability in the world. In the U.S., the estimated annual economic burden can range from $94 million to $102 billion U.S. dollars per year.

The condition can be debilitating to those living with it without proper management and treatment. But living a more stable, productive life may be possible for these adult patients. Symptoms can include delusions, hallucinations, and disorganized speech, as well as behaviors such as a lack of motivation or a lack of interest in daily life experiences.

These symptoms can considerably impair daily activities, including work and relationships with family and loved ones, making it difficult for adult patients to prioritize self-care and, when unmanaged, can create a cycle of crisis. That being said, it’s important to clarify that a schizophrenia diagnosis doesn’t mean that a person can’t go on to live a fulfilling life.

DR. ALVA: Desiree, you know, you’re so right. I think that stigma and a sense of, you know, futility almost pervades in the minds of many individuals, including clinicians, and you know, it’s not a bad idea for us to get everybody up to speed with the latest developments of where we’re at right now, how we might be able to tackle this condition, how we might be able to better serve the people that need our help.

MATTHEWS: Absolutely. I think giving hope back to the family, back to the patient and clearly laying out all of their options to manage this condition, both medication as well as therapy options.

DR. ALVA: Absolutely.

MATTHEWS: It’s also a condition that is unfortunately still misunderstood and stigmatized today – even by adult patients, their loved ones, and providers. So, we must do everything we can to support our adult patients living with schizophrenia and ensure they know about all of their treatment options, including long-acting injectables, and that living a more routinely normal life with schizophrenia is possible.

DR. ALVA: To reiterate what you said, this condition can profoundly affect every aspect of life for an adult living with schizophrenia. For most, schizophrenia is a chronic, lifelong disease that requires ongoing management and consistent treatment regardless of whether symptoms are present. Relapse, which may include symptoms that lead to episodes of psychosis, hallucinations, or other disruptive behaviors, is of particular concern for both healthcare providers and adult patients, so it’s very important to delay whenever possible.

With each relapse in schizophrenia, adult patients run the risk of further deterioration in function, such as an increase of symptoms or the need for an adjustment in dosing, reduced treatment response, and poorer outcomes in general.

In addition, a relapse can greatly disrupt an adult patient’s life, with events such as hospitalization, loss of employment, or dropping out of school. After a relapse, some adult patients do not ever regain their original level of functioning, making it even harder to get back to that sense of normality they may have had pre-diagnosis.

Therefore, it’s critical for providers like us to initiate treatment earlier in the disease course to delay the risk of relapse and set our adult patients up for success. Early treatment initiation is also important with consideration to what we call the “critical period” during the first few years after diagnosis. Desiree, can you provide details on that?

MATTHEWS: Certainly. The “critical period” is considered to be within the first 5 years following diagnosis, during which time the disease can progress rapidly. After this time, progression tends to plateau. While HCPs can work to treat the condition at various stages, initiating treatment early, during this critical period, may positively influence short- and long-term clinical outcomes.

DR. ALVA: You know, you’re so right Desiree. With my adult patients, I approach treating them during this critical period by enhancing their educational base. By letting them know that, left to its own devices, psychosis is truly neurotoxic. It creates more problems for people. It fries out different connections in the brain and then subsequently leads towards greater periods for which they might not necessarily respond to the same dose that would have actually provided some support for them. What are your thoughts with that?

MATTHEWS: I completely agree. And early on in the disease course, it’s important to not only educate the patients, but also their families, and giving them that hope that when it’s well managed, individuals can go on to resume their daily activities, whether that’s enrolling back into school, going back to work, and having really those meaningful connections with both friends and family.

DR. ALVA: So being more aspirational in nature, I love that.

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