Achieving Best Outcomes in Treatment of Schizophrenia
In an energetic Grand Rounds session on Thursday, September 11, Dr. Chekkera Shammi lead a passionate discussion on the Canadian Psychiatric Association Recommendations for the use of Long Acting Injectable (LAI) Antipsychotics in Schizophrenia Treatment.
A psychiatrist at Ontario Shores Centre for Mental Health Sciences (Ontario Shores), Dr. Shammi set the context by first reminding the group that when treating schizophrenia, it is important to note that resistance to medication is not the exception for individuals, it is the norm. The statistics show that 50 per cent of patients stop their treatment within the first 30 days of being discharged. In addition, non-adherence is not always deliberate, as sometimes logistics to accessing medication may cause disruptions.
In addition to non-adherence to treatment, it is important to note that there are several obstacles to improving outcomes in the overall treatment of schizophrenia. There are low rates of remission or remission not sustained, delays in adequate treatment, substance abuse, and limited responses to medication for negative symptoms.
"Schizophrenia is a brain disorder with depression as an integral part of it, as well as obsessive/compulsory and anxiety issues and possibly substance abuse. Antipsychotic medications are often only treating one aspect and that is part of the reason why many people remain facing difficulties."
The high incidence of relapse is cause for concern.
"Virtually everybody relapses if you stop your medication, with 10 per cent relapsing in the first six months."
The use of long-acting injectable (LAI) antipsychotics is therefore recommended to support the treatment of schizophrenia.
"If treatment can be sustained over the first few years, they have a greater chance of a good long term outcome."
Dr. Shammi noted the advantages to be clear.
"Medication intake is assured and there is always a record kept of when the medication was last administered."
While there is variation in use across the world, Canada sits at a 6.3 per cent utilization rate. Some may argue that while the autonomy that one has with oral medication is reduced with long term treatment, it is necessary.
"With this disease more autonomy may not lead to good outcomes."
The recommendations for usage suggest that LAI be discussed early with persons, information on the options available is provided, the discussions are ongoing, and Physicians be informed and trained on the usage and that they conduct follow up monitoring.