Future Opportunities in the Treatment of Schizophrenia

Researchers Exploring Ways to Identify Symptoms Sooner

Anticipate some significant changes in the treatment of schizophrenia over the next 10 years, from a move toward coordinated specialty care to harnessing the power of social media to help identify symptoms sooner, said John M. Kane, MD.

The median time between the development of their first psychotic symptoms to when people receive treatment is a staggering 18 months in the United States, according to a recent study conducted by Dr. Kane, Professor and Chairman, Department of Psychiatry at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New York.

“This is a huge challenge,” he said. “We have people experiencing psychosis and all of the sequelae and not getting any treatment. The question is what can you do about that.”

A number of factors contribute to untreated psychosis, Dr. Kane said, including issues such as stigma, confusion on where to seek help, and lack of mental health awareness. “They often think this is a reaction to stress and will go away if they get more sleep or exercise,” he added. 

Fortunately, researchers continue to explore new methods of tightening the window of untreated psychosis, he said. For example, social media may help identify people with psychiatric symptoms more quickly than usual. 

With people’s consent, investigators have tracked their social media posts and found their picture and language usage change as they develop psychosis, he said. In addition, looking at internet search history can reveal what individuals might be thinking or experiencing.

“How do we use modern technology and the tremendous presence of young people on social media to help inform this issue?” asked Dr. Kane, also Senior Vice President for Behavioral Health Services, Northwell Health, New Hyde Park, New York.

Along with this topic, Dr. Kane explored many other areas during his Psych Congress 2018 session, “Predicting What the Treatment of Schizophrenia Will Look Like in a Decade”, such as the advantages of coordinated specialty care. This multimodal team approach to the management of early-phase schizophrenia includes individual therapy, family therapy, cutting-edge medication management, and supported education and employment to help people return to school and work.

(Continued on Page 2)

[pagebreak]

(Page 2 of 2)

The National Institute of Mental Health (NIMH) funded the Recovery After an Initial Schizophrenia Episode–Early Treatment Program (RAISE–ETP) study, which sought to determine if coordinated specialty care would produce better outcomes in people with first episode psychosis, compared with usual care. It found advantages in outcome measures such as quality of life, symptoms, return to work and school, and retention in treatment. However, the research found no benefit in the rate of hospitalization.

“That’s something we need to address,” noted Dr. Kane, a frequent speaker at Psych Congress who has worked with schizophrenia patients for 35 years. “Adherence plays a big part in that, and it’s hard to get people to stay on medication for long periods of time.”

To that end, Dr. Kane also planned to discuss a tool recently approved by the US Food and Drug Administration (FDA)—a “digital” antipsychotic medication that features a novel way to track adherence. A tiny sensor, embedded in the tablet, emits a signal when it hits the body’s gastric contents. The message transmits through bodily tissue to a sensing patch worn on the torso and it is then transmitted to a mobile device showing the exact date and time at which the drug was swallowed.

Other topics Dr. Kane planned to cover included: 

• A large ongoing study that explores whether a long-acting injectable formulation could reduce the risk of hospitalization, particularly in young people with early-phase schizophrenia. “There’s still controversy about the need for and impact of long-acting formulations and the general use of medication for long periods of time,” he said. “There’s a lot of debate as to whether or not we should stop them after awhile. Do they cause unwanted changes in brain function in and of themselves? We still struggle with these questions.”

• The FDA’s recent approvals of 2 drugs to combat tardive dyskinesia (TD), a syndrome of abnormal, involuntary movements associated with antipsychotic drugs. “A lot of clinicians assume tardive dyskinesia is no longer a major concern because the newer antipsychotic drugs tend to have a lower risk of TD,” Dr. Kane said. “At the same time, some of the newer drugs are being used very widely to treat depression and mood disorders, so in effect, we’re seeing more people get these drugs. People need to be reminded of the risk.”

• The great deal of imaging-related data that show differences in the brains of people with schizophrenia, compared with healthy controls. In addition, early study findings suggest some specific changes in magnetic resonance imaging (MRI) resting state striatal connectivity are associated with antipsychotic drug response. “These are future opportunities of which we need to take advantage,” Dr. Kane said.

—Mike Bederka