Schizophrenia News: May 2015
This SharePost will be a roundup of the latest schizophrenia news linked to my own observations on the topic.
The theory has long been held that schizophrenia can be caused by the interplay of genetic and environmental factors. One news article I reported on some time ago showed 108 genes influence schizophrenia development.
H. Steven Moffic, MD in his "Take Home Lessons on Schizophrenia" letter in the Psychiatric Times, reporting on the 2015 APA Convention, goes as far as to write that we should replace the term "chemical imbalance" to describe this illness. Changing it to "genetic imbalance," he suggests, might make this illness palatable to patients, where once the term was stigmatizing.
My experience is that schizophrenia and bipolar run in my family along my maternal grandmother's side. I'm certain it has afflicted us Italians since the very first years we moved to America in the late 19th century. In the 1950s, a couple of us were institutionalized in homes, long before there was better treatment and when recovery was a dim star.
Maybe “genetic imbalance” is a better term after all.
Breakthrough medication with infrequent dose
One of my relatives has suffered from anosognosia, a schizophrenia symptom, for at least 10 years and hasn't recovered. This is the lack of awareness that you have an illness, and it causes people to believe their delusions and paranoid thoughts are real, thus they don't seek help.
They get sick, go in the hospital and are given medication, get out and stop taking the medication. Then they go back into the hospital, are given medication and promise to take it, only to promptly stop taking medication again when they get out.
For a person like this, who can often be persuaded to take the pills using the LEAP technique and motivational interviewing, as well as changing your persuasional tactics with a symptomatic individual, there's good news for them and their families.
The FDA has approved the first three-month-long injectable antipsychotic, Invega Trinza (three-month paliperidone palmitate.)
The patient must first be put on Invega Sustenna, a once-monthly injection, for at least four months. Data from a long-term maintenance trial, published in JAMA Psychiatry in March, showed that 93 percent of patients who took the three-month medication did not experience a relapse on it.
Imagine this: taking a depot medication only four times a year. This would also be helpful for patients who simply forget to take their medication because of a deficit in memory linked to cognitive impairment. Janssen said it hopes to have Trinza available commercially by mid-June.
Long-term use of antipsychotics
One of the other APA workshops was titled "Rethinking the Long-Term Use of Antipsychotics in Schizophrenia: For Everyone, No One, or Some?" Dr. Moffic is quoted that, in general, the dosage of antipsychotics matters. Small subgroups of patients require high dosages for help. In time-pressed sessions in clinics where individuals are shuffled in and out of the psychiatrist's office it's hard to fit in talking about "the role of medication among other aspects of treatment that can potentially help."
At the convention, one well-respected community psychiatrist, Sandra Steingard, MD, confirmed via her own self-study that those who suddenly discontinued their medication had worse outcomes. Between those who reduced medication and those who did not, there seemed to her no striking difference in outcomes after a few years.