Treating Schizophrenia: The Importance of Early Identification and Intervention

In this exclusive blog, Rakesh Amin, MD, provides expert clinical insights on the importance of partnering with patients and caregivers to set treatment goals and the utility of introducing long-acting injectables earlier in the treatment of schizophrenia.

Despite recent advances in mental health awareness, schizophrenia is still largely misunderstood and not optimally treated. As a psychiatrist who has treated patients living with schizophrenia for more than a decade, I understand the complexities of the disease and the treatment challenges faced by both providers and patients. I have also seen the role long-acting injectables (LAIs) can have in the treatment paradigm and how, for appropriate patients, they may help improve symptoms, prevent relapses, and reduce hospitalizations. Considering LAIs early in treatment, as well as educating health care professionals (HCPs), patients, and caregivers about LAIs as early as possible, can be helpful in managing schizophrenia.

LAI EDUCATION: THE EARLIER THE BETTER

Over the last decade, I have seen a slight increase in overall LAI use, but there is still room for growth. I think providers are still reluctant to prescribe LAIs due to a general lack of awareness about their efficacy and safety. We continue to prescribe daily oral medications without considering the adherence-related challenges some patients may experience. In contrast, LAIs offer flexible dosing and reassurance that a patient has the medication they need in their system. I believe education on LAIs, their mechanism of action, safety, and efficacy, and the role they may play in adherence should be taught in medical school so providers are equipped to have informed conversations with their patients at the start of their career.

INTRODUCE LAIS AT THE START OF TREATMENT CONVERSATIONS

No matter the therapeutic condition, all medications have risks and benefits, and it is important to consider both when facilitating informed treatment decision-making. In my experience, discussing LAIs with my patients, caregivers, and family members early in their treatment journey and positioning LAIs in a positive light as an option that enables flexibility and convenience may help to overcome some of the stigma around LAIs as a punitive treatment option. For example, when considering options for a patient who is ready to move beyond a daily oral medication, I often note that LAIs come in multiple dosing and frequency options. Informing patients, caregivers, and family members about these benefits can help alleviate some concerns or misperceptions they may have.

GETTING PATIENTS AND CAREGIVERS ON BOARD AT THE OUTSET

When treating patients with schizophrenia, I employ a collaborative approach that includes input from both patients and caregivers to develop an individualized treatment plan. As reported in Psychology Research and Behavior Management, positive symptoms associated with schizophrenia, such as hallucinations and delusions, may lead some patients to resist treatment–especially LAIs. However, involving caregivers early in the decision-making process can support patient decisions and increase the chance of improved patient outcomes.

As psychiatrists, we have the opportunity to help people living with this complex mental health condition reach their goals. In my opinion, we should be working closely with patients, caregivers, and family members on an ongoing basis, as their needs and goals may evolve. Having early and open conversations and working together to build a treatment journey that meets patients’ needs and wants should be our collective mission.  

Reference:

Jameel HT, Panatik SA, Nabeel T, et al. Observed social support and willingness for the treatment of patients with schizophrenia. Psychol Res Behav Manag. 202;13:193-201. doi:10.2147/PRBM.S243722

Rakesh Amin, MD, an Oklahoma native, pursued his undergraduate years at the University of Texas in Austin. He then completed his residency in Psychiatry at the University of Florida. Dr Amin is dedicated to helping those with mental and behavioral health needs. He enjoys mentoring other HCPs and supporting the community through psychiatric medicine. An avid outdoorsman, Dr Amin has a particular interest in running, hiking, playing sports, and traveling. With a focus on healthy living, Dr Amin shares his passion and approach to a balanced lifestyle with his patients. He currently practices psychiatry in Nashville, Tennessee, and is CMO for Athena Care.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Psych Congress Network or HMP Global, their employees, and affiliates.