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Using Patient-Centered Assessment in Schizophrenia Care: Defining Recovery and Discussing Concerns and Preferences
Patient-reported outcomes are important for assessing the impact of schizophrenia and the success of treatment. Dr Correll discusses patient-centered care.
Abstract
Syndromal recovery, satisfactory quality of life, and adequate functionality are relevant goals that define successful treatment of schizophrenia. Recovery requires effective symptom control in multiple clinical domains but also sufficient self-care and social and educational/vocational functionality. The finding that residual negative and cognitive symptoms have been related strongly to inadequate levels of functioning in people with schizophrenia is related to the fact that current pharmacologic agents tend to be most effective for the positive symptoms of the disease. Additional challenges include psychiatric comorbidities and adverse events related to medication that can lead to secondary negative and cognitive symptoms and nonadherence, all of which can worsen outcomes. Treatment modalities that target cognition and functional rehabilitation without introducing tolerability issues are needed. In general, pharmacologic interventions should be combined with evidence-based nonpharmacologic treatments, and patient-reported outcomes as well as measurement-based care should be employed, ideally in a coordinated specialty care framework. To facilitate positive treatment decisions, a combined shared decision and motivational interviewing approach should be implemented.
From the Series: The Schizophrenia Remission Roller Coaster: Using Long-Acting Injectable Antipsychotics to Improve Adherence and Enhance Potential for Functional Recovery
To cite: Correll CU. Using patient-centered assessment in schizophrenia care: defining recovery and discussing concerns and preferences. J Clin Psychiatry. 2020;81(3):MS19053BR2C.
To share: https://doi.org/10.4088/JCP.MS19053BR2C
© Copyright 2020 Physicians Postgraduate Press, Inc.
Target Audience
- Psychiatrists
- Nurse practitioners
- Physician assistants
Learning Objectives
After completing this educational activity, you should be able to:
- Use guidelines, clinical characteristics, and a patient-centered approach to select medication treatment for patients with schizophrenia who often relapse
- Incorporate nonpharmacologic therapies to optimize patients’ potential for functional recovery
Support Statement
Supported by educational grants from Alkermes, Inc.; Otsuka America Pharmaceutical, Inc. and Lundbeck.
Learning Objectives
After completing this educational activity, you should be able to:
- Use guidelines, clinical characteristics, and a patient-centered approach to select medication treatment for patients with schizophrenia who often relapse
- Incorporate nonpharmacologic therapies to optimize patients’ potential for functional recovery
Release, Review, and Expiration Dates
This brief report activity was published in March 2020 and is eligible for AMA PRA Category 1 Credit™ through March 31, 2022. The latest review of this material was in February 2020.
Statement of Need and Purpose
The goals of schizophrenia treatment are to control symptoms, prevent relapse, and improve functioning and quality of life. For many patients, these goals are not being met. Evidence demonstrates that long-acting injectable (LAI) antipsychotics are one of the most effective ways to prevent relapse in patients with schizophrenia, yet they remain underused. Health care providers infrequently discuss LAI antipsychotic options with their patients with schizophrenia. Clinicians also may overestimate adherence or not even assess it despite guideline recommendations. Patients with multiple relapses are often continued on oral medications, and few clinicians consider LAIs early in the course of illness. Health care providers need education on the efficacy, safety, and dosage/administration of LAIs, as well as on discussing LAIs with their patients. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on schizophrenia.
Disclosure of Off-Label Usage
Dr Correll has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this activity.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by a peer reviewer who is without conflict of interest.
Acknowledgment
This brief report is derived from the teleconference series “The Schizophrenia Remission Roller Coaster: Using Long-Acting Injectable Antipsychotics to Improve Adherence and Enhance Potential for Functional Recovery,” which was held in September and October 2019 and supported by educational grants from Alkermes, Inc.; Otsuka America Pharmaceutical, Inc. and Lundbeck.
Faculty Affiliation
Christoph U. Correll, MD
Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
Financial Disclosure
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Dr Correll is a consultant for and received honoraria from Acadia, Alkermes, Allergan, Angelini, Axsome, Boehringer-Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, ROVI, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; has received grant/research support from Janssen and Takeda; is a member of the speakers/advisory boards for Alkermes, Allergan, Angelini, Gedeon Richter, IntraCellular Therapies, Janssen, LB Pharma, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; is a stock option holder of LB Pharma; and has received other financial or material support for expert testimony from Bristol-Myers Squibb, Janssen, and Otsuka, and royalties from UpToDate.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
MOC Approval Statement
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, Using Patient-Centered Assessment in Schizophrenia Care: Defining Recovery and Discussing Concerns and Preferences has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:
MOC Part II CME Activity
Psychiatry and Neurology
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation