Inside Schizophrenia Podcast: Innovations in Treatment

Desiree Matthews, PMHNP-BC, is a board certified psychiatric nurse practitioner with over a decade of experience in mental health treatment, providing top-tier care for those living with severe and persistent mental illness. Desiree is the founder and clinical director of Different Mental Health Program (MHP), which provides a virtual, personalized, and holistic approach to mental health care for patients in North Carolina. In addition to clinical practice, she serves as a member of the steering committee for US Psych Congress and has served faculty appointments with US Psych Congress, Psych Elevate, NP Institute, and with NEI. She is passionate about bringing practical future-focused healthcare education to healthcare providers to improve their patient outcomes.

Rachel Star Withers creates videos documenting her schizophrenia, ways to manage and let others like her know they are not alone and can still live an amazing life. She has written Lil Broken Star: Understanding Schizophrenia for Kids and a tool for schizophrenics, To See in the Dark: Hallucination and Delusion Journal. Fun Fact: She has wrestled alligators.

To learn more about Rachel, please visit her website, RachelStarLive.com.

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To learn more about Gabe, please visit his website, gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Schizophrenia. Hosted by Rachel Star Withers, an advocate who lives openly with Schizophrenia. We’re talking to experts about all aspects of life with this condition. Welcome to the show!

Rachel Star Withers: Welcome to Inside Schizophrenia, a Healthline podcast. I’m your host, Rachel Star, here with my amazing co-host Gabe Howard. The go to treatment for schizophrenia has been oral antipsychotics since the 50s. However, the landscape of schizophrenia treatment is changing and evolving from advancements in antipsychotic long-acting injections to promising new treatments targeting muscarinic receptors, different types of neuromodulation stimuli of the brain, and even new theories connecting schizophrenia to other diseases like CTE. All of this is leading to new innovations in schizophrenia treatment. Joining us today to share some of the upcoming treatment innovations for people with schizophrenia is Desiree Matthews, a psychiatric mental health nurse practitioner. Desiree is a new breed of psychiatric nurse practitioner who is at the forefront of helping people who are suffering from treatment resistant depression and schizophrenia take back control of their mental health.

Gabe Howard: Let’s start with kind of a common one. I believe that everybody in the schizophrenia space has heard of long lasting injectables. So let’s cover that first.

Rachel Star Withers: Most of us have taken antipsychotics. The oral route, meaning you take pills every day. Another way to take antipsychotics is through a long-acting injection. And people ask me this a lot. Have I tried it? I have not. In fact, I’ve never had anyone in the mental health community as far as, like professionals offer it to me. I think they should be offered more. It could be a difference in forgetting to take your pills. Some of these you take every two weeks, some might be four weeks or even monthly, but you go in and you get an injection. That’s all you have to worry about till the next time. I think it’s fascinating. So, I’m like, how do you go from taking a pill to an injection that lasts a month? Does it just float in your body? Like, how does your body know not to gobble it up? Your body’s like, no, no, just a little bit today. That’s outside of my brainwaves. Gabe.

Gabe Howard: It is absolutely incredible to think about this idea that you can do something on one day that’s going to give you the correct dosage of medicine that you need every day for the next 30, until you need to renew it. But of course, long lasting injectables are not without some controversy. Let’s say that after a week you realize, oh, this drug is not for me. These side effects are not for me. It is causing me issues. And I wish to get these issues to stop. That drug, or course, is in your system for another 30 days. Now. Doctors of course take this into account, but it is one of the immediate pushbacks that people give.

Rachel Star Withers: In the beginning, long acting injectables was mainly used to treat who were people that you called non med compliant, meaning that they wouldn’t take their medication and now they’re trying to use that to more broader things. And you think how many medicines exist. I know that birth control is a big one. That you can just go in and get like a shot for. It’s not like they know that people taking birth control are non-med compliant. It’s just easier. And so now I feel like that’s been the big push is for people with schizophrenia. How can we make this easier to manage across the board. So, especially if you’re someone who has been on a certain medication for a long time, the same dosage asking for a long acting injectable might be really helpful. Another thing that they’re trying to push is for early phase or first episode psychosis. And I find this interesting. It’s like a quick way to make sure somebody takes the meds, but I do. I do worry a little bit there about permission.

Gabe Howard: You’ve illustrated a lot of the good things about the drug, and I want to make sure that our listeners hear this. And, and I sort of hate being the negative Nelly in the room. But of course, I think one of the things that people in the schizophrenia community are worried about is what you just said, this idea that it could be forced upon them in some way and they wouldn’t have any control. You can see where any adult who feels like they’re not in control of their own body is going to resist that, and especially if you’re already sick, or if you’re already paranoid, or if you’re already having disorganized thinking, if you’re already working with your caregiver, your medical team in a way that you don’t feel included or in a partnership, this introduction of, oh, we’re just going to jab you with these drugs and whatever happens, happens can be very scary. There could be a trauma response as well. Many people with schizophrenia who have been inpatient may have been subdued with what’s called a chemical restraint or, you know, the shot to the butt. Some people have called it like the booty shots and things like that. But it’s somebody’s in crisis. They’re panicked, they’re worried, they’re scared, they’re sick, and then they’re given this shot. And so when they hear about it, they’re immediate knee jerk reaction is, no, that’s dangerous and bad. And I don’t think that we’re going to do any caregiver’s listening or any medical personnel listening by only talking about its positives. And I’m glad you did all this research, because there are a lot of people that are like, what? It’s so convenient. Why do people with schizophrenia not like it? Those are some reasons.

Rachel Star Withers: On the innovation side, they are working with the injections. Some of them are oil based versus water-based formulas. They’re playing with like how to inject these best of all so your body metabolizes them differently. It also helps with the pain of the injection. They’re working on injection locations to injecting it deep into the muscle versus into the fat of your body and intervals. Right now we’re looking at every few weeks monthly, even every three months. But they’re working on six months. Be able to take certain meds. One shot keeps you good for six months. And who knows, maybe a whole year. Which would be great if you are somebody who you’ve been on the same medication, this is what works great for you to be able to come in once a year and get your medication would be really cool. When you look at how many people with schizophrenia who are without homes, quote unquote, homeless, a lot of them can’t afford medication and can’t take their medication every day. But let’s say you’re able to pull them in and give them a once a year shot that could help that demographic.

Gabe Howard: I agree with that completely. The upside is absolutely there. And I think about taking a daily pill. I’m only going to speak for myself as someone who lives with bipolar disorder when I was diagnosed at 25, none of my friends had pill minders. They weren’t taking daily pills. So it was a little microaggression, almost a little subtle daily reminder that I was different from my other peers. And if I could have just had a once a month or a once a year, or a once a quarter shot, I would have felt more normal. And I think that has real value as well. From a mental standpoint and from a wellness standpoint, as long as we’re addressing both sides of the coin and really making sure that the patient has a real understanding of the risk benefit reward. And I do think that that’s sometimes missing with long lasting injectables.

Rachel Star Withers: Moving away from antipsychotics. There is a new thing that is on the horizon called muscarinic receptor activators. I had never heard of this before, Gabe, but I’ve also never been good at science, so maybe everyone else paid better attention than I did in school. To break it down for people similar to me, muscarinic receptors are like switches and the medication can affect the switches, turning them on and off inside of us. Antipsychotics usually work off a dopamine receptor. These muscarinic receptors work off different ones, and they have been found to have an antipsychotic-like effect and help with cognition. That is exciting to me. That part right there. Because there isn’t really any treatment for the cognitive decline in schizophrenia. The muscarinic receptors also are being looked at to work for treatment resistant schizophrenia. So people again, like me, who’ve tried all the antipsychotics and they don’t work for them or they barely work, this could be a new route. That’s pretty amazing when you think that, hey, I’ve been on all the antipsychotics. None of them worked. Doesn’t matter how I take them. You can give me injections, you can give me patches. They’re just not going to work. This is a whole new avenue of medication that might work for you. It is new, but they are saying that it has less side effects than antipsychotics.

Gabe Howard: If it had less side effects, I would be really into that. Like, that would be incredible.

Rachel Star Withers: As we’ve talked about on the show, I’ve had electroconvulsive therapy. Neuromodulation is alteration of nerve activity in your brain via stimulation. So modified electroconvulsive therapy. It’s very much different than what I had many years ago. They keep working with the different electricity and using it on the brain. Transcranial direct current stimulation. Transcranial focused ultrasound using audio waves. And a very interesting one that is available to some areas is transcranial magnetic stimulation, TMS. What’s interesting is that they found that auditory hallucinations mainly come from the auditory cortex in your brain, and it’s this area that is making these hallucinations. Using the transcranial magnetic stimulation, they’re able to get just that little area and just kind of focus all of their stuff on that. I could see a lot of potential in that. If they’re able to figure out the different areas of your brain that are messing up and then be able to, whether it’s electricity, ultrasounds or magnets, be able to focus on that, it could help relieve a lot of symptoms.

Gabe Howard: Rachel, I’m just curious. Because you live with schizophrenia, do you consider this to be too invasive? It does seem like it’s along the same vein of electroconvulsive therapy, ECT and electric shock therapy, ECT, it has a lot of fear surrounding it. A lot of people are afraid of it. How do you feel about these new treatments?

Rachel Star Withers: On the surface. If you’re comparing it to ECT, then yes, it still has that bad rep of being scary and oh, I don’t want people messing with my brain. If you look at some of the other ways. So for instance, the transcranial focused ultrasound, everyone knows what an ultrasound is. Pregnant women don’t go being terrified to get their first ultrasound. It’s exciting. It’s neat. I had an ultrasound done on my heart recently. It was kind of cool. I’m like watching my little heart on the screen and I’m like, I want, you know, I kind of wanted a picture as if it was my little baby, you know?

Gabe Howard: I like that.

Rachel Star Withers: If we focus more on the ultrasound techniques, the magnetic stimulation, I don’t think people are scared of that because they’re used to those type of procedures in other parts of the body.

Gabe Howard: It’s interesting to think about stimulating the brain leading to wellness. That’s really what we’re searching for. Right? But I got to say, when you have a heart condition and people do things to the heart that make sense, if you have a broken bone and people are doing things directly to the bone, that makes sense to people. But when you have a broken brain, you’re like, don’t touch my brain. Well, but if that’s where the area that is suffering. So that part does track for me. But, from the outside looking in. Rachel, I really think about cognitive issues. Issues thinking, gathering thoughts, speaking. You know, we talk about word salad. Are these innovations doing anything to really impact those symptoms of schizophrenia? Because I know the people who live with schizophrenia, they want to articulate and be able to think and be able to share and be able to communicate. And people who love people with schizophrenia want to be able to talk to their schizophrenic loved ones and have them understand and be able to reply back. That’s a that’s really the crux of, I think, everything that our listeners are. How is the research and innovation into that symptom coming?

Rachel Star Withers: Antipsychotics has been the go-to medication all these years, they don’t help with cognition. So just think about that, Gabe. Over the past 50 plus years it hasn’t even really been treated in anybody with schizophrenia. So they have been working to find new ways to hopefully deal with that part of schizophrenia. The muscarinic receptors might help with that. Also different add-ons. So, adding amino acids, working with sodium channels, potassium channels, even vitamin C to help offset the side effects from antipsychotic drugs, beef up your brain and keep the cognition from declining. Now notice I said declining, not necessarily going backwards, but they’re looking how can we improve the brain health of people with schizophrenia. They have to figure out what causes the deterioration first. And sometimes figuring out what helps you discover the cause.

Gabe Howard: Is their frontline research being done into this in a robust way, or is it sort of on the outskirts?

Rachel Star Withers: I’m not a researcher, but I do a lot of research for the podcast, of course, and just looking to treat my own schizophrenia, I personally feel that it’s on the back burner that when people think of treating schizophrenia, they of course the knee jerk reaction is, well, we got to keep them from going crazy. We don’t want them to have psychosis. We don’t want them hallucinating and hearing voices. And the cognition is, yeah, it is being studied, but it’s not on the forefront.

Gabe Howard: Rachel, I feel my role in this episode is to be the negative Nelly and I’m going to do it again. I, I don’t think it’s fair to do an episode on the research into schizophrenia and innovations in schizophrenia treatment without addressing a little bit of some of the issues with it. And the issue is there’s not a lot of money in schizophrenia treatments not compared to other drugs that can be released or research that can be done. There’s a lot of money in cancer research because there’s a lot of profit to be made in cancer treatment. There’s not a lot of money in schizophrenia research because there’s not a lot of money to be made in schizophrenia treatment. Now I just want to address that because what we’re talking about, these innovations, we get this idea that there’s this robust team of doctors who are just doing everything they can fighting for the cure. And I’m not saying that that never happens. I’m not saying that there’s no front-line research, but I do want to level set a little and let our listeners know that, no, by and large, a lot of our innovations are serendipitous. They were researching something else, and during clinical trials, they found out that it could possibly be an indication for schizophrenia. And that’s when the research started. But to actually just wake up in the morning and say, I’m going to research schizophrenia and see what I could find, that doesn’t happen as much as we need it to, and as much as we believe that it does. I do want to point that out for our listeners, just so they know, encourage doctors, pharmaceutical companies. This is why we advocate to get more research. Awareness really matters in this arena.

Rachel Star Withers: So, what you’re saying, Gabe, you are exactly right. The way to make people research schizophrenia more is to have them care about it. Find a way for them to make money off of it So, they’ve been expanding treatment for schizophrenia by looking at other diseases that are very similar. For instance, Alzheimer’s, dementia, Parkinson’s, autism. These tend to get a lot more research done because they’re more popular. Something that’s been in the news the past few years is CTE, which is chronic traumatic encephalopathy. For those of you who follow the news, that’s what they think that a lot of the big NFL players keep getting from all of the head hits is that they go, quote/unquote, uncrazy because of the traumatic brain injury that they sustain. They’ve been looking at how close that is to schizophrenia. The behavioral changes, the apathy, the memory loss, the disorientation. That’s a good thing because everybody’s talking about NFL players. And is football too dangerous here in America. That’s getting the spotlight shone on it. And hey, if we if we as people schizophrenia can ride on the back of the treatment for the CTE in NFL stars. Awesome. Great. Because yeah, that’s a hot topic right now in research.

Gabe Howard: And that’s great. And it definitely lends itself to the serendipitous nature of how schizophrenia treatment works, which again, I do want people to keep in their minds just so they can advocate best. I really do think a lot of listeners like, oh, look, there’s so many innovations, they must be working round the clock on it. Nope. We’re just borrowing from other people. But like you said, Rachel, make no mistake, borrowing from other people is fantastic. I don’t care where we get the breakthrough as long as we get the breakthrough.

Rachel Star Withers: Talking about all these different treatment innovations. We also have new hypotheses and theories on what causes schizophrenia. They’re out there testing different experiments to see what does and what doesn’t work. One of the theories is could gray matter loss in our brain be a core symptom of schizophrenia? And if you stop the loss of the gray matter, would that stop schizophrenia progression? Along the same lines, cellular aging has been seen in schizophrenia, which I had no idea that I’m aging quicker than everyone else. That’s a little worrisome, but they think that that is part of the reason that many of us have neurodegeneration is that the cells in our brain are aging quicker than they should. Another theory is how can we think differently about schizophrenia? Anosognosia is a lack of insight, where people with schizophrenia tend to not think that they have a mental disorder, even though their loved ones tell them, look, there’s something wrong with you.

Rachel Star Withers: The doctors say, look, no, you have this diagnosis. They don’t seem to think that anything has changed. Everyone all along says that is a symptom of schizophrenia. But what if it was the other way around? Interoceptive awareness is our body’s ability to be able to perceive the internal state. Your heart rate, your respiration, your position where your arms at, where your legs are. Like all of that stuff kind of going on in our brain. However, certain people, if they’ve had a stroke or other types of diseases or disorders, can become impaired. They also have anosognosia or lack of insight. They have theorized that maybe it starts with anosognosia. And then because you’ve lost that insight that leads you to hallucinate, maybe. What is wrong with you? I feel like that’s a stretch, but I do like that they’re kind of flipping the situation because we’ve just been treating it as a symptom. What if that’s one of the main causes? What if you treat that as a cause? Maybe the other schizophrenia symptoms go away.

Gabe Howard: It’s fascinating to look at things from a different perspective, right? That’s where the phrase think outside the box comes from. So while I’m in the same boat as you, I don’t know that I necessarily can get behind this or even understand it. I like that we’re looking at it differently, because we’ve largely looked at schizophrenia and schizophrenia symptoms in the same way for generations. Anybody who’s doing any new research into something to get a different glimpse or a different angle or create that seed that can lead to something great I’m all for.

Sponsor Break

Rachel Star Withers: And we’re back talking about innovation in schizophrenia treatment.

Gabe Howard: Rachel, we’ve covered a lot here and you’ve done great research as a layperson, but I think it’s time to bring in an expert. You interviewed Desiree Matthews, who is a psychiatric mental health nurse practitioner. She’s going to share with us information about two of the treatment options that we discussed, long lasting injectables. And of course, they’re available right now. And muscarinic receptor agents that may be available in the coming months. All right, let’s go ahead and roll that interview right now.

Rachel Star Withers: Thank you so much for joining us today. We’re speaking with Desiree Matthews, who is a psychiatric mental health nurse practitioner. Desiree, before we get started, I want to know what attracted you to working in the mental health field?

Desiree Matthews, PMHNP-BC: Thank you, Rachel, so much for having me today. You know, mental health field. This is really near and dear to my heart. It affects family members both on my mother’s side as well as my father’s side. Unfortunately, like many people, there’s stigma associated with mental health. And I had the same bias and misconception that I think a lot of people in the audience and general public may have about mental health. And, it wasn’t until I went to nursing school and actually did a rotation in psychiatry that I realized mental health, this is not somebody’s fault. They didn’t ask for it. It’s not something they did to themselves. And I just really had an aha moment. And I felt quite ashamed that I thought I was fairly well educated that, you know, my family was well educated, but we didn’t understand mental health. And having that exposure in, in nursing school really made me see how strong and how resilient, really some of my family members have been living with their mental health conditions, and I felt that it was really my calling and my duty to help clear up these misconceptions and really provide really good care, compassionate care and care from, really from a point of view that if this was my family member, what would I want from them?

Rachel Star Withers: What are some of the recent breakthroughs for schizophrenia treatment?

Desiree Matthews, PMHNP-BC: Right now it is an exciting time in terms of research with understanding the brain. We’ve had a lot of advancements in just how we study the brain and how we study mental health, when we think about specifically about schizophrenia treatments, I would say there’s been two really big advancements recently. So, first, our long-acting injectable antipsychotics being more readily available in different formulations. We now have medication for schizophrenia that somebody only has to take twice a year now instead of 365 days a year. Because I don’t know about you, Rachel, but, you know, sometimes I forget my medication. I think I forgot it today, actually, when I was busy actually prepping for this podcast. I mean, everybody forgets their medication. So being able to allow patients to take, you know, medication every one month, every two month, every three months, or now, every six months, just twice a year to cover them for their symptoms of schizophrenia is quite an advancement from taking a pill every single day. So, number one, there’s that. Number two, we have had essentially the same treatment, Rachel, for 70 years

Rachel Star Withers: Mm-hmm.

Desiree Matthews, PMHNP-BC: And for schizophrenia. And that’s by blocking the D2 receptor, these dopamine or D2 antagonists. And what we know about schizophrenia now is that this is actually a presynaptic problem. So, if you look at imaging in the brain and we can actually see now in images of the brain and these studies where there’s dopamine synthesis. So, we actually have excess dopamine in part of the brain called the striatum. And this is what we think is responsible for positive symptoms associated with schizophrenia like hallucinations or delusions. We’ve been really blocking those receptors so that the dopamine can’t communicate with it, when in fact it’s really a presynaptic problem. But we have a postsynaptic or kind of an afterthought of you know, being able to block that signaling or that communication with dopamine. And unfortunately, with these D2 blockers or antipsychotics, they come with a lot of baggage and side effect, because these dopamine receptors live in other parts of the brain other than the area that’s, you know, we’re trying to block because of the hallucinations or delusions. So we get things like movement disorders, like tremors, drug induced parkinsonism. Maybe people feel really stiff or super restless from their medication. This is because the medication is going into other parts of the brain, like the motor track, where we don’t want it to be. We can see endocrine dysfunction. So unfortunately our medications can impact how our body responds to glucose. So insulin sensitivity, we actually have dopamine receptors on our pancreas. We have dopamine receptors and our hypothalamus. So this can affect the body’s ability to regulate sugar levels or glucose levels in individuals. Taking these D2 blockers may be more prone to developing diabetes as well as weight gain.

Desiree Matthews, PMHNP-BC: Our medications currently that we have available in some individuals, it can actually worsen somebody’s cognition. So being able to think clearly, remember, learn. And it also can cause negative symptoms. So things like diminished pleasure or interest in things called anhedonia, it can actually decrease dopamine in parts of the brain that we don’t want it to. So now Rachel, we have these muscarinic activators that are currently in development. Just to preface this, nothing is FDA approved yet, but we should hear a decision from the FDA on a new mechanism of action as early as the end of September. So these are likely coming. And there’s many companies with multiple agents in development that are these muscarinic activators. And these are selective and they actually decrease dopamine pre-synaptically. So, they’re actually almost getting to the root of the problem instead of just blocking and doing a full stop on like, nope, no dopamine for you. It actually reduces the dopamine early on, and there’s not the collateral damage that we may see with our traditional D2 blockers or antipsychotics, because we know many people have issues with side effects, and that can lead us to stop medication. And there’s some individuals that have treatment resistant schizophrenia that don’t respond to our current treatment. Some people can’t tolerate the current treatment we have. So I’m really excited for the future that we may have opportunities to help a whole group of people that we haven’t been able to reach before with our current treatments.

Rachel Star Withers: Rolling back for a second. How do long acting injectables work versus taking a daily pill? Like how I understand taking a daily pill, but let’s say taking injectable that’s going to last six months. How does is that just the body metabolizes it different.

Desiree Matthews, PMHNP-BC: Yeah. So we’ve come pretty far with what I would call drug delivery technology. So, we’ve had typical or kind of your early generation antipsychotics like haloperidol, for instance, available in a long-acting injectable form for quite some time right now. But really, what’s gotten better over the years is truly the drug delivery technology and the ability to slowly release medication over one month, two months or even six months. We also have options now that are subcutaneous. I don’t know if you’ve heard of that, Rachel, but subcutaneous long acting injectables that are risperidone based. So that’s kind of the molecule risperidone. And it can be given every one month or every two months. And I’d like to explain it to people. It’s almost like you know, like an insulin pen. So, it goes into the back of the upper arm in kind of the fatty tissue. Or you can do it around like the abdominal or abdomen area. You know, just having differences where you can inject also really helps because at the end of the day, it’s all about making that individual feel comfortable. If you don’t want an injection in your gluteal area, that’s, that’s okay. We have the arm. We have the sub-Q options now. So it’s really all about that technology that has really been able to deliver longer and longer acting intervals, as well as different injection site and techniques that we can use now.

Rachel Star Withers: With the muscarinic agents. Would you still take an antipsychotic also? Or is it supposed to completely take the place of antipsychotics?

Desiree Matthews, PMHNP-BC: So, right now the clinical trials there is actually an add on treatment with traditional antipsychotics. So I guess when I say antipsychotic now maybe we need to clear up that terminology.

Rachel Star Withers: Okay.

Desiree Matthews, PMHNP-BC: Right? Rachel. So we have our D2 blockers, our traditional antipsychotics that we’ve been using for seven decades now. And then we have the muscarinic activators that are not FDA approved but could be very soon in the future. We have a lot of proof that these muscarinic activators can be used. monotherapy. In fact a muscarinic agent was actually studied originally in Alzheimer’s cognition, believe it or not. But they saw signals that it reduced hallucinations and some positive symptoms like psychosis in these individuals. So they went on to actually do a very small trial of around 20 or so individuals living with schizophrenia. And they saw very profound effects, even in such a small trial, that it was giving very much quote/unquote antipsychotic properties or reducing those symptoms associated with schizophrenia.

Rachel Star Withers: Desiree, how can our listeners learn more about you and your work?

Desiree Matthews, PMHNP-BC: Thank you Rachel. I do have a private practice here in North Carolina. It’s telehealth and you can visit www.DifferentMHP.com to see what we’re all about. Also I’m really active on LinkedIn, both my personal page as well as my practice page. So, my name is Desiree Matthews, psychiatric nurse practitioner. And then my business or practice name is called Different MHP. That stands for Different Mental Health Program. Because that’s really what we’re all about is providing a different experience for individuals, especially if they’ve had difficulty in the past with their treatment. So, we definitely want to provide different treatment, different ways to tackle mental health, because we know it’s not just about medications, it’s really our whole mind and body that we really need to be mindful of to take care of.

Rachel Star Withers: Thank you for joining us today, Desiree, and sharing your knowledge with us.

Desiree Matthews, PMHNP-BC: Thank you so much, Rachel, I’m so happy to be here and happy to come back anytime.

Gabe Howard: Rachel, as always, excellent interview. I’m curious, after hearing from our guests and all of the other treatment innovations for schizophrenia, is there any that rose to the top for you? What are you most excited about?

Rachel Star Withers: Anything that focuses on cognition that over the past few years that symptom of schizophrenia, the deterioration of my brain and the reading, writing, that cognition stuff that that’s been the hardest for me to deal with. I see it speeding up, which is worrisome to me. And the fact that we have researchers out there who realize this, that this is a main issue when it comes to helping people with schizophrenia. That makes me happy. And I, of all the different things that I heard, the muscarinic receptor agents, I’m excited to see how those are going to do with people whether the FDA is going to approve them. What it takes to roll that out, honestly, how do you take them? Is that going to be like your normal pills? Is that going to be an everyday thing? Is it going to be an injection? We don’t really know yet. But I feel like that’s an exciting new area that we’re all seeing unfold before us. The other is the neuromodulation advancements. Doctors are used to doing ultrasounds on little babies on different parts of your body. I think that the ultrasounds on your brain, once they figure out the nuances of all that, is going to open up a whole new treatment area for us. What about you? Of all the different ones I’ve seen, have any of these new treatments stood out to you?

Gabe Howard: I have always been most excited about the long lasting injectables, because I really see their value in leading a normal life, and especially when people are sick. You know, one of the issues with the pill is that it gives them one day and then they have to take it again, and it gives them one day, and then they have to take it again, and it gives them one day, and it has to build up the long lasting injectables seem to have some data that shows that they can work quicker. And of course you get the one shot and you’ve got 30 days. That’s a lot more data than one day. And I, I think if we’re honest, it’s difficult to remember to take a once daily or a twice daily pill, hard stop. That’s not for people with schizophrenia. That’s for people we all know the person who didn’t finish their antibiotic from the doctor. We all know the person that forgot to take their pill for high blood pressure. When you’re putting an illness on top of it, I can really see how this can really set somebody up to be successful. And I think that’s worth discussing. But I can also see where it’s very scary.

Gabe Howard: And I think that we need our caregivers and our medical community and society at large to have more understanding that even treatments that have huge upsides and huge promise also have potential downfalls and negatives, and somebody who is scared of that is actually thinking very rationally. I want to say to all the caregivers out there, you know, there’s so many people living with schizophrenia who are taking their medication as prescribed, who are listening to the doctors, and they are not getting better. And the first thing that people think is that the person with schizophrenia must be doing something wrong. I love the long lasting injectable because once that shot is given, if 30 days later that person is not better, nobody can blame them for it. And I really like that because I really feel like people with schizophrenia get blamed for a lot of things that, frankly, aren’t their fault.

Rachel Star Withers: It’s easy for people with schizophrenia and their loved ones, caretakers to feel hopeless about treatment, especially if you’ve been on a lot of different antipsychotics and they haven’t worked or they barely worked. If you have treatment resistant schizophrenia, chronic schizophrenia, but people are still studying schizophrenia and how our brains work, still coming up with theories and hypotheses and experimenting on us, which sounds bad, but it’s pretty cool at the same time because those are people who want to know, how can we help this person with schizophrenia? Each step in the discovery process gets us closer to finding new schizophrenia treatments that work for you and me. Thank you so much for listening to this episode of Inside Schizophrenia. Please like, share, subscribe and rate our podcast and we’ll see you next time here on Inside Schizophrenia, a Healthline Media podcast.

Announcer: You’ve been listening to Inside Schizophrenia, a podcast from Psych Central and Healthline Media. Previous episodes can be found at psychcentral.com/is or on your favorite podcast player. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. Thank you and we’ll see you next time.