Considering a new standard of care in schizophrenia
As a psychiatrist, I have observed that schizophrenia is a widely known, but poorly understood mental health condition. People living with schizophrenia may experience mild to severe symptoms, such as delusions, hallucinations, or disorganised thinking. When left untreated, these symptoms can be frightening, confusing, and isolating.1
In addition to the many challenges of navigating life with these symptoms, people living with schizophrenia often experience stigma related to their diagnosis. These stigmas can result in social exclusion and impact their relationships with others.2 In my opinion, a key aspect of reducing these stigmas is by helping providers, patients, and caregivers better understand the disease through education and helping people with schizophrenia achieve and sustain symptom control through early diagnosis and intervention.
While treatment for schizophrenia is a lifelong commitment, with the right combination of medication and psychosocial support, patients may have an opportunity to experience an improved quality of life and reach their goals, which may include maintaining relationships, holding a steady form of employment, and being productive members of their communities.
Nuanced care: Collaboration between the individual and the HCP
However, treatment for schizophrenia is nuanced and requires collaboration between the individual and healthcare professional to establish an individualised treatment plan. I have seen some patients question their initial diagnosis. Additionally, some may also experience what is called “anosognosia,” or a lack of insight into their illness. Once a diagnosis has been established, most patients require medication to manage both positive and negative symptoms.3,4
The current standard of care is a combination of individualised therapy and medication. Choosing the right medication requires a personalised approach, based on the symptoms each patient may or may not be experiencing. Antipsychotic medications, widely prescribed for schizophrenia, can reduce certain symptoms of the illness, such as hallucinations and delusions. However, they can cause bothersome side effects. These symptoms and manifestations can range from weight gain, diabetes, and heart conditions to reduced sexual drive and menstrual problems. As a result, non-adherence - related to side effects, psychosocial factors, and the impact the condition has on cognition - is a challenge.
Delivery options for antipsychotic medicines
Antipsychotic medications are available in two delivery options: oral and long-acting injectables (LAIs). In my professional experience, LAIs tend to be a lesser-known option, even within the healthcare professional community. Some evidence suggests that the prevalence and burden of schizophrenia is increasing.5 To address this upward trend, it is imperative to raise awareness about LAIs, which I believe can help many patients consistently manage symptoms.
The majority of oral medications prescribed to treat schizophrenia are taken on a daily basis. Unfortunately, such a dosing schedule means non-adherence will not be detected until a major problem develops.6 In contrast to oral medications, LAIs have a variety of dosing schedule options, which are often more suitable to the lifestyles of my patients.
Recent reports show there are currently 3.5 million people diagnosed with schizophrenia, but only about 10% of patients are on an LAI.7 I believe there may be a hesitancy to prescribe LAIs due to a lack of awareness, clinical experience, and resources. However, in my opinion, many patients with schizophrenia would benefit from LAIs. Earlier and improved education among the healthcare community is a pivotal first step, followed by patient and caregiver partnership in the decision-making process.8
Why long-acting injectables should be the standard of care in schizophrenia
For my peers who are just learning about LAIs, I would offer detailed patient case studies and experience from my practice. I have witnessed LAIs improve symptoms and prevent relapses which can lead to hospitalisations and other serious outcomes.
There are several LAIs available. One such treatment I often prescribe is ARISTADA® (aripiprazole lauroxil), a prescription medicine given by injection by a healthcare professional and used to treat schizophrenia in adults. This medication is available in several different doses including monthly (441 mg, 662 mg, 882 mg), every 6 weeks (882 mg), and every 2 months (1064 mg), allowing me to tailor each treatment regimen to my patient's needs. It is not known if ARISTADA is safe and effective in children under 18 years of age.
In some of my patients with schizophrenia taking ARISTADA, I have seen a reduction in symptoms such as delusions, social withdrawal, and hallucinations. More importantly, I have witnessed improved adherence rates and feel the reduced dosing schedule offers a convenient option for patients. I would strongly advocate for LAIs to be considered as an option both early in a patient’s treatment journey and for the long-term maintenance of their disease.
Despite the significant challenges in the treatment of schizophrenia, there are promising treatment options that can help improve patient outcomes. I believe that by incorporating LAIs into clinical practice, we can improve the treatment experience for individuals living with this complex mental health condition. While there is no cure for schizophrenia, with the right care plan and a supportive care team, patients can have the opportunity to live meaningful and productive lives.
- Living Well with Schizophrenia. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/serious-mental-illness/schizophrenia. Accessed April 14, 2023.
- Schizophrenia. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/schizophrenia. Accessed April 14, 2023.
- Jameel HT, Panatik SA, Nabeel T, et al. Observed social support and willingness for the treatment of patients with schizophrenia. Psychology Research and Behavior Management. 2020:13. 193–201.
- Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014:Sep;39(9):638-45.
- He H, Liu Q, Li N, et al. (2020). Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the Global Burden of Disease Study 2017. Epidemiology and Psychiatric Sciences. 2020:29,e91:1–11.
- Marcus SC, Zummo J, Pettit AR, et al. Antipsychotic adherence and rehospitalization in schizophrenia patients receiving oral versus Long-Acting Injectable antipsychotics following hospital discharge. J Manag Care Spec Pharm. 2015;21(9):754-68.
- Schizophrenia Statistics. FHE Health. https://fherehab.com/schizophrenia/statistics#:~:text=Schizophrenia
%20been%20diagnosed. Accessed April 14, 2023.
- Kane JM, McEvoy JP, Correll CU, Llorca PM. Controversies surrounding the use of Long-Acting Injectable antipsychotic medications for the treatment of patients with schizophrenia. CNS Drugs. 2021:Nov;35(11):1189-1205.