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Understanding the Complexity of Diagnosing and Living with Schizophrenia

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(BPT) - More than 20 million people worldwide are living with schizophrenia — a chronic, serious and often severely disabling brain disorder.[1],[2]

Schizophrenia ranks as one of the top 15 leading causes of disability globally.[3] However, it can be difficult for people to receive an accurate schizophrenia diagnosis, as the condition is frequently stigmatized or confused with other disorders. Following diagnosis, many people spend years searching for treatment that works for them.[4]

What do schizophrenia symptoms look like?

Schizophrenia may be recognized by a wide range of signs. These are broken up into positive and negative symptoms. Positive symptoms can cause a person to actively experience hallucinations, delusions and disorganized thinking. These indicators can be more easily recognized and are typically what lead individuals to seek treatment. These symptoms often remain the primary focus of treatment plans.

Negative symptoms including lack of activity or emotion, social withdrawal, and cognitive impairment are often harder to recognize and can be confused with other serious mental health conditions. Because of this, they are less likely to be addressed initially and may lead to additional problems, such as impaired memory, attention, and the ability to make decisions.[1] Additionally, these sometimes unrecognized symptoms can have an impact on those living with or caring for someone with schizophrenia.

The spectrum of symptoms experienced by people living with schizophrenia can make it difficult to find the right treatment that addresses an individual’s symptoms. However, most people with schizophrenia (60%) only have partial symptom control.[5] To help address this need, researchers are developing new therapies.

How is schizophrenia treated?

Schizophrenia treatment typically includes a combination of medications, psychotherapy, and other specialty care services. While psychotherapy practices have evolved over the years, the therapeutic standard of care for schizophrenia has not changed much since the 1950s. The most commonly prescribed medications, called “atypical antipsychotics,” involve blocking the activity of chemicals in a person’s brain, specifically dopamine and serotonin.[5] They effectively treat positive symptoms, such as psychosis or disconnection from reality, but are less effective at treating negative symptoms.[5],[6],[7]

Additionally, up to 74% of people stop using their medication, citing side effects as the reason.[8] Side effects of atypical antipsychotics may include weight gain or metabolic effects.[8] Furthermore, many people with this condition inaccurately believe they no longer have schizophrenia once their symptoms improve and that they no longer require treatment if their symptoms are controlled with medication.[8]

“The goal of treatment for people living with schizophrenia is to find the best medication for an individual which will help to reduce symptoms that have a significant impact on their daily lives,” said Maitri R. Patel, M.D., Progressive Therapeutics LLC. “To achieve this goal providers work hard to have honest communication with patients to determine how their treatment is progressing. This way providers and patients can collaborate to determine if treatment changes are necessary and what types of supportive care are best for this individual.”

Are researchers developing new treatments?

Recent research indicates that trace amine-associated receptor 1 (TAAR1) may play a significant role in balancing the activity of central nervous system (CNS) neurotransmitters including dopamine, serotonin, and glutamate that are dysregulated in people with schizophrenia.[9],[10] A new investigational medicine, ulotaront (SEP-363856), is currently being evaluated in Phase 3 clinical trials. This drug is a TAAR1 agonist with serotonin 1A (5-HT1A) agonist activity – meaning it targets different receptors in the brain than currently available treatments. According to a study published in the New England Journal of Medicine, ulotaront showed improvements in the symptoms of schizophrenia compared with placebo in clinical studies of patients with schizophrenia. The most common adverse events reported in the study included tiredness, agitation, nausea, diarrhea and indigestion.[9]

Research continues to progress, and novel therapies are being explored that may have the potential to offer patients another treatment option to address the symptoms of schizophrenia. If you or a loved one experience symptoms of schizophrenia, it is important to seek help from your healthcare provider to find a management strategy that works best for you.

References



[1] World Health Organization. Mental Disorders. [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/mental-disorders. Accessed April 2021.

[2] Bo, Sune & Haahr, Ulrik. (2016). Early-Onset Psychosis and Child and Adolescent Schizophrenia. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. 4. 1-3. 10.21307/sjcapp-2016-001.

[3] National Institute of Mental Health. Schizophrenia. [Internet]. Available from: https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Accessed November 2019.

[4] Fellner C. (2017). New Schizophrenia Treatments Address Unmet Clinical Needs. P & T: a peer-reviewed journal for formulary management, 42(2), 130–134.

[5] Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. PT. 2014;39(9):638-645.

[6] Lieberman JA, Stroup TS, McEvoy JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia [published correction appears in N Engl J Med. 2010 Sep 9;363(11):1092-3]. N Engl J Med. 2005;353(12):1209-1223.

[7] Stepnicki P, Kondej M, Kaczor AA. Current Concepts and Treatments of Schizophrenia. Molecules. 2018;23(8):2087.

[8] Liu-Seifert H, Adams DH, Kinon BJ. Discontinuation of treatment of schizophrenic patients is driven by poor symptom response: a pooled post-hoc analysis of four atypical antipsychotic drugs. BMC Med. 2005;3:21.

[9] Koblan KS, Kent J, Hopkins SC, et al. A Non-D2-Receptor-Binding Drug for the Treatment of Schizophrenia. N Engl J Med. 2020; 382(16):1497-1506.

[10] Rutigliano G, Accorroni A, Zucchi R. The Case for TAAR1 as a Modulator of Central Nervous System Function. Front Pharmacol. 2018;8:987.