Update on the Treatment of Schizophrenia: Phases of Illness and Treatment Goals by Prof Correll
Christoph Correll, MD, is professor of Psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York, and Medical Director of the Recognition and Prevention (RAP) program at the Zucker Hillside Hospital in New York.
He completed his medical studies in Berlin and Scotland and his research, and clinical work focuses on the identification, characterisation and treatment of adults and youths with severe psychiatric disorders, with a further focus on psychopharmacology and the risk-benefit evaluation of psychotropic medications.
Professor Correll has authored or co-authored over 450 journal articles, has received over 30 national and international research awards and fellowships for his work and is listed by Thomson Reuters as one of “the most influential scientific minds” and “top 1% cited scientists in the area of psychiatry.”
In a way, quality of life is really an amalgamate of efficacy, tolerability, functionality, and adherence, and actually, when patients have a better quality of life they have better adherence and when they have less side effects they also have better quality of life.
In order to know whether somebody is not ‘better’ but ‘well’ we need an absolute outcome, and that’s called remission. Since 2005, this is defined as 6 months of no more than mild positive and mild negative symptoms (4 positive, 4 negative).
The question is, what is the block on the road to recovery, where do we fail, what is going on, what do we do wrong, why can’t we help our patients enough? It’s because people are not stable for long enough so that you can rehabilitate them to reintegrate them.
The body and the brain are connected through the neck, so it’s not only that you have a heart issue, we know that inflammation is bad for your brain too.
Prof Correll begins his presentation with an introduction to the treatment of schizophrenia and explains how quality of life is important in patient management.
Moving on to treatment goals, Prof Correll discusses the efficacy of antipsychotics and the adverse effects of domains such as depression, cognition, and schizophrenia in addition to the traditional focus on total symptoms (positive and some negative).
Prof Correll presents an overview of the different phases of illness and patient outcomes for remission and recovery. He highlights the importance of determining functionality in order to define symptoms and discusses the problems of relapse.
Highlighting the known decrease of 10-25 years life expectancy in people with psychiatric disorders, Prof Correll talks about how a healthy, active life and the right medications are critical in preventing relapse and increasing quality of life.
He discusses how the Australian population of people with psychotic disorders have extremely high cardiometabolic burden and how the Australian guidelines recommend monitoring and approval of outcomes to decrease cardiovascular risk.
Take home messages:
- Quality of life is important, but many physicians fail to ask patients about this
- Less than half of all chronic patients will achieve symptomatic stability for 6 months or more
- Dopamine modulation has resulted in fewer neuromotor and cardiometabolic side effects
- When people stop taking medication, they experience a cycle of relapse which interrupts the road to recovery
- After each relapse, approximately 1 in 7 people will not have the same response to the same medication as before
- Patients need to be treated from the onset of symptoms with the lowest risk medication that allows them the best psychiatric and physical outcome
For clinicians, the simplified guide to antipsychotics is a useful tool in understanding mechanisms of actions of antipsychotics and through this understanding choosing antipsychotics with a lower metabolic burden.
3. Galletly CA, Foley DL, Waterreus A, et al. Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Aust N Z J Psychiatry. 2012 Aug;46(8):753-61.