Maintainence treatment of Schizophrenia

1. SCHIZOPHRENIA MAINTAINENCE TREATMENT

2. OUTLINE OF THE PRESENTATION
 Schizophrenia
 Management of schizophrenia
 QoL as treatment goal
 Antipsychotics and QoL

3. SCHIZOPHRENIA: INTRODUCTION
 Schizophrenia is characterized by 3 broad categories of symptoms:
 positive symptoms,
 negative symptoms, and
 cognitive symptoms.
 Chronic course with heterogeneous outcomes
 Associated with significant functional impairment, challenges in community living, and burden of
disability
 Affects many other spheres of living, such as interpersonal and socio-occupational domains
Indian J Psychol Med 2019;41:420-7.

4. SCHIZOPHRENIA MANAGEMENT: GOALS
 Traditionally, the goals of schizophrenia management1
 Treating positive and negative symptoms
 Recently: more holistic approach that emphasizes functional recovery, psychosocial functioning, quality
of life (QoL)1
 Over a decade ago, Naber and colleagues proposed that quality of life should be considered as
important as psychopathology in managing patients with schizophrenia.2
 Achieving symptomatic remission with antipsychotic medications is the necessary first step to functional
recovery,3 and the prevention of clinical relapses will have the greatest impact on QoL.4
 Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study: Clinical effectiveness alone may
not necessarily translate to improvements in QoL and patient self-rated life satisfaction.5
1. Juckel & Morosini. Curr Opin Psychiatry 2008;21:630-9. 2. Naber et al. Schizophr Res 2001;50:79-88. 3. Kokaçya et al. Noro Psikiyatr Ars 2016;53:328-33. 4. Briggs et al. Health Qual Life
Outcomes 2008;6:105-13. 5. Fervaha et al. Eur Neuropsychopharmacol 2014;24:1078-85.

5. MANAGEMENT OF SCHIZOPHRENIA
 Antipsychotic medication is the mainstay of treatment of schizophrenia.
 The pharmacotherapy of schizophrenia has undergone substantial changes.
 Research over the past decade has shown that about 80% of patients with schizophrenia respond to
drugs, of these 20% recover well after the first attack.
RFP Indian Journal of Medical Psychiatry. 2019;2(2-3):61–68

6. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry. 2020

7. ANTIPSYCHOTICS

8. EVOLUTION OF ANTIPSYCHOTICS AND MOA

9. D2 RECEPTOR PARTIAL AGONISM: Optimal Level of Intrinsic
Activity

10. EFFECTIVNESS OF ANTIPSYCHOTICS
RFP Indian Journal of Medical Psychiatry. 2019;2(2-3):61–68
ANTIPSYCHOTIC NNT
Haloperidol 3(2, 5)
Olanzapine 8(5, 27)
Quetiapine 5(3,13)
Amisulpride 6(4, 11)
Aripiprazole 4(6,13)
Cariprazine 10(7,18)

11. DRPAS AND ACTIVATION IN SCHIZOPHRENIA
NUMBER NEEDED TO HARM

12. ANTIPSYCHOTICS & QOL IN SCHIZOPHRENIA

13. FACTORS INFLUENCING THE QOL
 Variety of factors influencing the outcome of QOL of patients on antipsychotics.
 Side effects
 Daily dosing,
 Treatment time
 Tolerability of medications
 Impact on cognitive functions, negative and depressive symptoms,
 Compliance,
 Previous experience with medications
 Social functioning.
RFP Indian Journal of Medical Psychiatry. 2019;2(2-
3):61–68

14. FACTORS INFLUENCING THE QOL
 A systematic review conducted was conducted by AHRQ(Agency for the health care research & Quality).
 These are the key findings:
a. Olanzapine, aripiprazole, risperidone, quetiapine, and ziprasidone were similar in function, quality of life, mortality,
and overall adverse events.
b. Core illness symptoms were better with olanzapine and risperidone than asenapine, quetiapine, and ziprasidone,
and with paliperidone than lurasidone and iloperidone.
c. Haloperidol had similar benefits but more adverse events than olanzapine and risperidone. •
(McDonagh et al. 2017)

15. FACTORS INFLUENCING THE QOL
d. Psychosocial treatments improved outcomes versus usual care: assertive community care (core illness symptoms,
function), cognitive behavioral therapy (core illness symptoms, function, quality of life), cognitive remediation (core
illness symptoms), family interventions (core illness symptoms, function, relapse), illness self-management (core
illness symptoms), Psychoeducation (core illness symptoms, function, relapse), social skills training (core illness
symptoms, function), and supported employment (core illness symptoms, employment).
(McDonagh et al. 2017)

16. SUMMARY
 Schizophrenia has a chronic course with heterogeneous outcomes
 QOL is important outcome in patients suffering from schizophrenia
 Antipsychotics are the main stay of therapy for patients suffering from schizophrenia
 Second-generation antipsychotics have better improvement of QoL compared to first-generation
antipsychotics

17. THANK YOU!