Optimizing Management of Schizophrenia with Long-acting Injectables - Episode 1

Prevalence and Treatment Challenges of Schizophrenia

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Kimberly Garcia, DNP, CRNP, explains how widespread schizophrenia is and the challenges and unmet needs of treatment.

Sanjai Rao, MD, DFAPA: Hello, and welcome to this Psychiatric Times® PsychView series titled “Optimizing Management of Schizophrenia With Long-Acting Injectables.” I’m Sanjai Rao, a clinical professor of psychiatry and an associate residency training director at the University of California, San Diego, and the site director for residency training at the VA [Veterans Affairs] Medical Center in San Diego, California. We have with us Kimberly Garcia, the director of the psychiatric nurse practitioner program and an assistant clinical professor in the department of advanced practice nursing, nurse practitioner, and a doctor of nursing practice programs at the College of Nursing and Health Professions at Drexel University in Philadelphia, Pennsylvania. Thank you for joining us. Let’s get started.

Kimberly, I’ve been looking forward to this conversation. Schizophrenia is a huge part of what we treat, and I’m certain for you as well. I thought we’d start with a little background information for our audience. Talk a about how big of a problem schizophrenia is and some of the challenges and unmet needs you face when you’re treating patients with schizophrenia.

Kimberly Garcia, DNP, CRNP: Thank you for inviting me to participate in this session. I believe schizophrenia is a very significant issue. I work in community mental health, and we see individuals who tend to have refractory symptoms or are established in their disease trajectory. Schizophrenia, in my practice, makes up approximately 40% of our overall patient population.

Sanjai Rao, MD, DFAPA: That’s huge. You obviously see many more than a lot of people do. I work at an inpatient unit, so I’m in a similar situation as you. I see an outsized amount of patients with schizophrenia relative to what’s in the population.

Kimberly Garcia, DNP, CRNP: Yes.

Sanjai Rao, MD, DFAPA: Even if you consider what’s out there in the population at large, it’s around 1%, which doesn’t sound huge until you do the math and figure that’s around 2.5 million or more people who have schizophrenia. I was thinking about some of the unmet needs. Many times, when I see a patient, it’s someone on the younger side, someone recently diagnosed. They may not have a lot of psychosocial support. They may never have been sick in their life before, and so it’s hard for them to wrap their head around this idea that they’re sick. There’s a lot of difficulty with insight into the illness.

Kimberly Garcia, DNP, CRNP: Absolutely, and that goes in line with some of the core features associated with the disease process. It’s very hard when the patient is suspicious or paranoid or lacks insight to even establish rapport and be able to discuss treatment options.

Sanjai Rao, MD, DFAPA: I completely agree. I’m sure that as part of that, you see what I see, which is that if you’re suspicious of the diagnosis, the treatment, and all that that, then you may not continue with the treatment. You may end up relapsing, and that’s obviously something that we see a lot in schizophrenia.

Transcript edited for clarity.