November 2014 MRC2.CORP.X.00004

Transcription

1 This program is paid for by Otsuka America Pharmaceutical, Inc. and Lundbeck, LLC. The speaker is a paid consultant of Otsuka America Pharmaceutical, Inc. advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.

2 Updates in Schizophrenia: Research, Remission, and Recovery Otsuka America Pharmaceutical, Inc., Rockville, MD advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.

3 Symptoms of Schizophrenia Positive Unusual thought content (delusions) 1,3 Hallucinations 1,3 Conceptual disorganization 1,3 Negative Affective flattening 1,2 Apathy 3 Anhedonia 3 Avolition 1,2 Cognitive Impaired attention 3,4 Impaired working memory 3,4 Impaired executive functioning 3,4 1. American Psychiatric Association. DSM American Psychiatric Association. Am J Psychiatry. 2004;161 (2 Suppl):1-56; 3. NIMH Web site. Accessed October 3, 2013; 4. Velligan DI et al. Schizophren Res. 2004;71:

4 Theoretical Course of Illness for Schizophrenia Variable degrees of recovery First psychotic episode Premorbid phase Cognitive, motor, or social deficits Prodromal phase Brief/ attenuated positive symptoms and/or functional decline Psychotic phase Florid positive symptoms Stable phase Negative symptoms, cognitive/ social deficits, functional decline Childhood Adolescence/young adulthood 1. Tandon R, et al. Schizophr Res. 2009;110:

5 Goals of Treatment Acute phase 1 Prevent harm, control disturbed behavior Reduce severity of psychosis/ associated symptoms Address the factors that led to the acute episode Effect rapid return to the best level of functioning Develop alliance with the patient and family Formulate short- and long-term treatment plans Connect patient with appropriate community aftercare Maintenance phase 2,3 Consolidate gains of acute therapy Prevent recurrence of illness, maintain response Maintain medication adherence Maintenance options include oral or injectable antipsychotics 1. APA Guideline Summary 2 nd edition. NGC Kane JM. CNS Spectr. 2010;15(4 Suppl 6): Davis JM, Chen N. J Clin Psychiatry. 2003;64 Suppl 16:

6 Remission and Recovery as an Outcome Remission 1 Symptoms rated as absent, minimal, or mild on PANSS At least 6 months Recovery A lack of clarity continues to exist regarding how recovery is to be defined; differing and sometimes contradictory opinions exist 2 May be best to define recovery in terms of specific domains 3 Increasingly regarded as an achievable outcome 4 Estimated recovery rates: 4% to 27% over 1 2 years 4 PANSS, Positive and Negative Syndrome Scale. 1. Andreasen NC, et al. Am J Psychiatry. 2005;162: Starnino VR. J Hum Behav Soc Environ. 2009;19(7): Lieberman JA et al. Psychiatr Serv. 2008;59(5): Emsley R, et al. Curr Opin Psychiatry. 2011;24:

7 Definition of Recovery Recovery = symptom remission + independent* psychosocial functioning Recovery Cure One example of a proposed operational definition: Brief Psychiatry Rating Scale score of 4 on all positive and negative psychosis items 50% work or school; independent management of funds and medications; once weekly socializing with peers At least 2 years duration *Patient does not need to be living on their own to meet criteria; may include being productive at work/school, social relations, family life, and recreational activities. Liberman RP et al. Psychiatr Servi. 2005;56:

8 Brain Structure and Function Features Which May Be Seen in Schizophrenia MRI PET MRS DTI Note: Not all patients with schizophrenia display these structure and function features. Adapted from Schizophr Res, Vol 113, Yoshida T, et al, pp84-94., 2009, with permission from Elsevier (upper left). Adapted from Am J Psychiatry, Ragland JD, et al, 2009;166(8): American Journal of Psychiatry, Copyright American Psychiatric Association (upper right). Adapted from Biol Psychiatry, Vol 68, Ongür D, et al, pp , 2010, with permission from Elsevier (bottom left). Adapted from Schizophr Res, Vol 108, Ellison-Wright I, Bullmore E, pp.3-10., 2009, with permission from Elsevier (bottom right). 8

9 Looking Ahead: Future Trends and Developments Recognition that dozens or hundreds of different lesions 1 and genetic mutations 2 may contribute to clinical syndromes Emphasis on prevention: early detection and intervention 1 Reducing or reversing cognitive deficits is now recognized as a key goal for treatment 1 Growing number of targets for pharmacologic therapy 1 New pharmacologic, nonpharmacologic treatments 1 Moving care delivery from fragmentation to integration 1 Eliminating stigma 1 1. Insel TR. Nature. 2010;468: Nasrallah AH. Curr Psychiatr. 2013;12:6-7. 9

10 For more information or to request a live presentation from your local Medical Science Liaison, please visit advice or professional diagnosis. Users seeking medical advice should consult with their physician or other healthcare professional.