These untreated symptoms are roadblocks to patient recovery
NEW YORK, NY (March 7, 2005) – Treatment of schizophrenia has largely focused on controlling positive symptoms, such as hallucinations and delusions, while another set of symptoms that are equally important to patients is frequently overlooked by physicians, according to the findings of a new national consumer survey and the authors of a new consensus statement aimed at raising the bar for the treatment of the brain disease.
Comprehensive treatment of all schizophrenia symptoms is possible and many people with schizophrenia can now recover in ways not previously thought possible, according to the panel of nationally recognized psychiatrists and psychologists whose discussions and recommendations are published in a supplement to the current issues of Primary Psychiatry and CNS Spectrums (CNS Spectr. 2005;10(2 Suppl 1):1-16). A copy of the supplement can also be accessed at http://www.mblcommunications.com/proceedings.php3.
"Traditionally, physicians have been oriented to treating schizophrenia by preventing symptoms from getting worse, rather than helping the person continue to get better beyond their current level of symptoms and functioning," said Peter J. Weiden, MD, professor of psychiatry and director of the Schizophrenia Research Service at State University of New York (SUNY) Downstate Medical Center in Brooklyn, an author of the statement. "But we now know that by taking a long-term focus and tackling a broader range of symptoms, many patients do steadily improve so that they can function better, and live fuller, more complete lives."
While medications to treat schizophrenia's positive symptoms (such as hallucinations, delusions, and disorganization) have existed since the mid-20th century, newer medications introduced in the early 1990s, known as atypical antipsychotics, also control the often overlooked symptoms of depression, suicidal thoughts, and problems remembering or concentrating (affective and cognitive symptoms). Yet "dealing with affective and cognitive impairment has not yet become prominent on the clinical horizon," according to Nina R. Schooler, PhD, adjunct professor of psychiatry at Georgetown University School of Medicine, an author of the statement.
The supplement and consensus statement were developed to encourage physicians to address the debilitating effects of depression, cognitive impairment and other aspects of the disease that dramatically impact the quality of life for people with schizophrenia," said David L. Ginsberg, MD, director of Outpatient Services, Tisch Hospital Department of Psychiatry at New York University Medical Center and section editor of MBL Communications, Inc., publishers of Primary Psychiatry and CNS Spectrums.
The supplement, entitled Optimizing Treatment of Schizophrenia: Enhancing Affective/Cognitive and Depressive Functioning, includes a discussion of the results of a new Harris Interactive® national consumer survey of people with schizophrenia, which clearly illustrates the problem:
65% reported that, when making treatment decisions, their doctors place "a great deal" of importance on positive symptoms while only 37% felt their doctor places "a great deal" of importance on cognitive symptoms. Among those taking antipsychotics, 77% said their medication does not adequately help their ability to focus and concentrate. Among those taking antipsychotics, most (74%) also feel their current medication falls short in controlling depression while 49% of all respondents said their doctors place "a great deal" of importance on depression when making treatment decisions. Yet patients report that it is as important to control affective and cognitive symptoms such as depression (77%), problems doing daily activities (85%), and inability to focus/concentrate (81%), as it is to control hallucinations and delusions (84%).
"Failure to control the affective and cognitive disease symptoms is one of the biggest barriers preventing many patients today from achieving a meaningful social and occupational recovery," said Philip D. Harvey, PhD, professor of psychiatry at Mount Sinai School of Medicine and chief psychologist at Mount Sinai Hospital, an author of the statement. "We believe it is important for doctors to look beyond the control of positive symptoms and consider the affective/cognitive benefits of medication to help patients achieve a 'functional' recovery."
Studies suggest that atypical antipsychotics improve cognition better than older antipsychotics, but even atypical antipsychotics differ in their ability to treat these symptoms. In a large-scale study, patients who had not responded well to prior treatment with risperidone, olanzapine, or conventional antipsychotics were switched to ziprasidone, one of the newer atypical antipsychotics, and showed statistically significant improvement in cognitive symptoms.
Not only do atypical antipsychotics differ in their ability to improve cognition, they have different side effect profiles. Weight gain in particular has become a problem with some medications. The survey shows that more than 75 percent of patients on antipsychotic medications gain weight and of those who said they gained weight, the average weight gain is 52 pounds. Fortunately, at least two of the newer medications are not associated with weight gain. The authors advise that factors such as side effect profiles are predictable and individual preferences should be considered.
People with schizophrenia agree with the optimistic views expressed in the consensus statement. The survey found that virtually everyone with schizophrenia (94%) believes that daily functioning is part of successful treatment for schizophrenia and most (83%) believe with the right medications, people with schizophrenia should be able to lead full lives.
In addition to Drs. Weiden, Schooler and Harvey, Peter F. Buckley, MD, professor and chairman of the Department of Psychiatry and Behavioral Health at the Medical College of Georgia, is also an author of the statement.
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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