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Schizophrenia Update: Navigating the Latest in Research and Treatment - Module 4: Applying the Latest Therapeutic Advances to Patient-Centered Care
Schizophrenia is a complex illness with diverse symptoms and outcomes, influenced by both genetic and environmental factors. In Module 4 of this series, we focus on the importance of a patient-centered approach to treatment. Discover how evidence-based strategies and shared decision-making can be used to tailor care for each individual, fostering holistic recovery. Watch this video to learn how to optimize care through cooperative relationships and personalized treatment for patients with schizophrenia. STATEMENT OF NEED Schizophrenia is a complex mental illness characterized by diverse symptoms, presentations, and prognostic outcomes. Much of this variation is attributed to the disease’s multifactorial origins, including genetic and environmental influences. Individualizing therapy for schizophrenia requires a patient-centered approach that incorporates evidence-based strategies and shared decision making, with the goal of holistic recovery tailored to each individual (Chien et al, 2013). It is crucial for members of the interdisciplinary care team to understand the individual experiences of patients, form cooperative relationships with patients and caregivers, and implement shared decision making to optimize care. In Module 4 of this activity, Dr. Christoph U. Correll, Professor of Psychiatry and Molecular Medicine at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, and Professor and Chair of the Department of Child and Adolescent Psychiatry at Charité – University Medicine in Berlin, Germany, will bring together recent advances and clinical care into providing patient-centered care for schizophrenia. TARGET AUDIENCE Psychiatrists, psychiatric nurse practitioners, psychiatric physician assistants/associates, psychiatric mental health nurses, pharmacists, and other healthcare professionals involved in the treatment of patients with schizophrenia LEARNING OBJECTIVE Upon completion of this activity, participants should be able to Apply the latest therapeutic advances and strategies for shared decision making to individualized treatment planning for patients with schizophrenia DISCLOSURE OF RELEVANT FINANCIAL INFORMATION WITH INELIGIBLE COMPANIES i3 Health endorses the standards of the ACCME, ANCC, and ACPE that require everyone in a position to control the content of a CME/NCPD/CPE activity to disclose all financial relationships with ineligible companies that are related to the content of the CME/NCPD/CPE activity. CME/NCPD/CPE activities must be balanced, independent of commercial bias, and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession. A conflict of interest is created when an individual has an opportunity to affect CME/NCPD/CPE content about products or services of an ineligible company with which he/she has a financial relationship, which therefore may bias their opinions and teaching.
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Schizophrenia Update: Navigating the Latest in Research and Treatment - Module 4: Applying the Latest Therapeutic Advances to Patient-Centered Care
- 1. Schizophrenia Update: Navigatingthe Latest in Research and Treatment l Module 4: Applying the Latest Therapeutic Advances to Patient-Centered Care Christoph U. Correll, MD Professor of Psychiatry and Molecular Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Professor and Chair, Department of Child and Adolescent Psychiatry Charité – University Medicine, Berlin, Germany FOR PERSONAL USE ONLY
- 2. Disclosures Advisory board orpanel: AbbVie, Allergan, Angelini, Boehringer Ingelheim, Bristol Myers Squibb, Cerevel, Compass, Gedeon Richter, Janssen/J&J, Karuna, LB Pharma, Life Science, Lundbeck, MedInCell, Merck, Neuraxpharm, Neurelis, Neurocrine, Newron, Novo Nordisk, Otsuka, Recordati, Rovi, Sage, Seqirus, Sunovion, Supernus, Teva, Vertex, Viatris Consultant: AbbVie, Allergan, Angelini, Boehringer Ingelheim, Bristol Meyers Squibb, Cerevel, Compass, Denovo, Eli Lilly, Gedeon Richter, IntraCellular Therapies, Janssen/J&J, Karuna, Kuleon Biosciences, LB Pharma, Life Science; Lundbeck, MedInCell, Medlink, Merck, Mindpax, Neuraxpharm, Neurelis, Neurocrine, Newron, Novo Nordisk, Otsuka, Recordati, Relmada, Reviva, Rovi, Sage, Seqirus, Sunovion, Supernus, Teva, Vertex, Viatris Grants/research support: Boehringer-Ingelheim, Janssen, Takeda Stock/shareholder: Cardio Diagnostics, Kuleon Biosciences, LB Pharma, Medlink, Mindpax, Quantic, Terran i3 Health has mitigated all relevant financial relationships FOR PERSONAL USE ONLY
- 3. Overview of ActivityModules Module 1: Understanding the Evolving Treatment Landscape Module 2: Advances in Long-Acting Injectables Module 3: Emerging Treatments for Cognitive Symptoms Module 4: Applying the Latest Therapeutic Advances to Patient-Centered Care FOR PERSONAL USE ONLY
- 4. Learning Objective Apply thelatest therapeutic advances and strategies for shared decision making to individualized treatment planning for patients with schizophrenia FOR PERSONAL USE ONLY
- 5. Collaborative Care Planning Littrell& Littrell (1998). Psychiatric Annals, 28(7):371-377. During the planning process, several important functions are performed: Setting priorities and goals Appraising strengths Selecting appropriate interventions Determining resources Everyone works together to: Clarify personal choices Identify environmental options Clarify personal values Identify personal interests FOR PERSONAL USE ONLY
- 6. Shared Decision Making Elwynet al (2012). J Gen Intern Med, 27(10):1361-1367. Provides knowledge about the condition Including etiology, prognosis, and potential outcomes Inquires about patient preference Prior medication trials, lifestyle, and limitations Shares insight about treatment options Prior medication trials, lifestyle, and limitations Shares experience and values Preferences, socioeconomic circumstances, and experience of illness Voices their concerns Including personal risk tolerance and accessibility of treatment Asks questions of the provider Regarding treatment options, outcomes, and anecdotal experience Clinician Patients FOR PERSONAL USE ONLY
- 7. Positive Relationships CreateResults Elwyn et al (2012). J Gen Intern Med, 27(10):1361-1367. Shared Decision Making Clinicians and patients share the best available evidence. Patients are supported to consider the options Team Talk Work together, describe choices, offer support, and ask about goals Decision Talk Get to informed preferences, make preference-based decisions Option Talk Discuss alternatives using risk communication principles “Let’s work as a team to make a decision that suits you best" “Let’s compare the possible options” “Tell me what matters most to you for this decision” FOR PERSONAL USE ONLY
- 8. What Is MotivationalInterviewing? Correll (2020). J Clin Psychiatry, 81(3):MS19053BR2C. A style of dialogue between 2 parties, intended to motivate 1 party into making positive changes by compassionately challenging the status quo and helping them explore alternatives FOR PERSONAL USE ONLY
- 9. Set SMART Goals Slidecourtesy of Christoph U. Correll, MD. S Specific Focus on one area for improvement M Measurable Quantify or have a progress indicator for your measurable goals A Achievable Specify how to do it R Relevant Describe the results that are possible given your available resources T Time-bound Specify your target date or time frame for achieving the results FOR PERSONAL USE ONLY
- 10. Case Study: John Patient:John, a 28-year-old male diagnosed with schizophrenia 5 years ago; unemployed, living at home with parents Stopped olanzapine that he had responded to regarding positive symptoms due to weight gain 3 months ago, acutely exacerbated, and readmitted Presenting symptoms: auditory hallucinations, paranoid delusions, and thought disorder Treatment: risperidone titrated up to 4 mg daily upon discharge Outcome: positive symptom control but side effects emerged: Prolactin elevation: gynecomastia, low libido Weight gain: 12 kg over 6 months Sedation: daytime drowsiness Low motivation/fatigue FOR PERSONAL USE ONLY
- 11. Case Study: John(cont.) Patient unhappy and threatening to stop risperidone that parents had been sure to give in a supervised fashion every day due to fear of relapse Antipsychotic switch discussed. Reason for switch: Persistent cognitive fog and low motivation plus fatigue impacting daily functioning Side effects from risperidone affecting adherence and quality of life Treatment adjustment: Switched to cariprazine 4.5 mg: partial D2 dopamine agonist with lower cardiometabolic risks, less sedation, and potential utility for negative symptoms Outcome: cognitive clarity improved, less sedation and more motivation, no fatigue Weight loss 4 kg, prolactin levels normalized, no more sexual dysfunction FOR PERSONAL USE ONLY
- 12. Case Study: John(cont.) Challenge: Nonadherence emerged after initial success with cariprazine leading to less supervision of medication intake by parents as the patient felt “overly controlled” Missed doses intermittently for 2 months, leading to symptom exacerbation When challenged by parents, patient admits to insufficient adherence Intervention: Motivational interviewing and collaborative care with the patient and parents Explored reasons for nonadherence (“I am fine, I do not need this anymore”) and for taking medications (“I want to be able to go out with friends again and have some income”) Engaged family support and care team Outcome: switched to aripiprazole LAI (2-month formulation) FOR PERSONAL USE ONLY
- 13. Key Takeaways EPS =extrapyramidal symptoms. Personalization matters: adjust treatment based on efficacy-side effect balance and patient needs Address negative and cognitive symptoms: remove reasons for secondary negative and cognitive symptoms (EPS, weight gain, sedation) Switch to partial D2/3 agonist cariprazine for symptom stability, improved tolerability, and attenuation of negative/cognitive symptoms Support adherence: LAIs and motivational strategies for long-term treatment success Quality of life focus: balance symptom control and side effect burden with functional goals Case Study: John FOR PERSONAL USE ONLY
- 14. Key Takeaways CGI-S =Clinical Global Impression–Severity. Monitoring strategy: Symptom assessment with CGI-S and/or visual analogue scale for patient rated outcome Check body weight and glucose and lipid levels routinely Symptom severity, functionality, informant interview ask about symptoms, functioning Side effects: Sedation, cognitive clarity, sexual side effects Ask about functioning and quality of life/goal attainment and treatment engagement Case Study: John FOR PERSONAL USE ONLY
- 15. References Correll CU (2020).Using patient-centered assessment in schizophrenia care: defining recovery and discussing concerns and preferences. J Clin Psychiatry, 81(3):MS19053BR2C Elwyn G, Frosch D, Thomson R, et al (2012). Shared decision making: a model for clinical practice. J Gen Intern Med, 27(10):1361-1367. DOI:10.1007/s11606-012-2077-6 Littrell KH & Littrell SH (1998). Issues of reintegration and rehabilitation in schizophrenia. Psychiatric Annals, 28(7):371-377. DOI:10.3928/0048-5713-19980701-07 FOR PERSONAL USE ONLY