Management of Schizophrenia and Common Comorbidities By Prof Bernhard Baune
Prof Bernhard Baune, Ph.D., MD, MPH, FRANZCP, holds the Cato Chair and is Head of Psychiatry at the University of Melbourne. In 2011, he was appointed as Chair of Psychiatry and Head of Discipline of Psychiatry at the University of Adelaide. Under his leadership, psychiatry research at the University of Adelaide gained international recognition for excellence in neuroimmunology and genomics of mental disorders, and for innovation in molecular and clinical underpinnings of personalized psychiatry. Prof Baune has authored or co-authored 204 peer-reviewed publications and 14 book chapters.
Managing the area of schizophrenia and its comorbidities is very clinically relevant, and we have to treat holistically, and not just the positive and negative symptoms.
I was very pleased to see that David Castle and colleagues have at that figure [life expectancy] for schizophrenia here in Australia and found, in around 10,000 people, patients live around 11 years less long than the general population. It’s a different figure from the United States and may have shown some improvement, but it certainly is a figure which is still alarming.
What is also to be considered is that some of the anti-psychotic medication may induce or at least not reduce the symptoms of depression, so we need to be aware of the fact that some of the medications we might be using are not doing a favour to patients with depression and anxiety symptoms.
Summary and slides
Professor Baune begins his presentation by discussing the importance of treating schizophrenia holistically. He discusses recent advances in managing associated physical symptoms, many of which result from antipsychotic treatments.
He highlights the co-morbidities associated with antipsychotic use and the shift in clinical focus towards the metabolic side effects in recent years.
Moving on, he provides details of mental health co-morbidities associated with schizophrenia, the most notable being depression and anxiety, and emphasizes cognitive impairment as a predictive component of patient outcomes.
Professor Baune highlights the reduced life expectancy of patients with schizophrenia and presents the results of a large survey of patients. Alongside reductions in core schizophrenia symptoms, patients care most about avoiding weight gain, improving depression, and improving the overall quality of life.
He then discusses the high prevalence of depression and anxiety in patients with schizophrenia, the negative impact of this, and the fact that such co-morbidities are often undertreated.
The importance of differentiating between the negative symptoms of schizophrenia and any underlying depression and anxiety that requires treatment is highlighted. Treatment options are discussed later in the presentation.
- It is important for clinicians to consider broader treatment outcomes for patients with schizophrenia, as well as focusing on the classic positive and negative symptoms.
- In addition to reducing the core symptoms of schizophrenia, overall quality of life and functionality are most important to patients.
- It is important that clinicians take time to consider whether patients’ symptoms result from schizophrenia or are attributable to another underlying illness.
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