Schizophrenia: Critical Management Issues in First-Episode and Chronic Patients

Venue: Boston

Location: Boston, Massachusetts, United States

Event Date/Time: Oct 18, 2008
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Schizophrenia is a serious neuropsychiatric disorder that often leads to life-long impairment in societal functioning. Unfortunately, despite the availability of effective medications, the illness is too frequently characterized by incomplete remission after an acute psychotic episode, or a relapse after full remission because of insufficient adherence to antipsychotics.

It is estimated that adherence rates among patients with schizophrenia are between 50 and 60 percent, and that 50% to 75% of patients with schizophrenia will relapse within a year if they discontinue their medication, compared to only 25% of patients who continue their medication. Poor adherence prevents patients with schizophrenia from enjoying the full spectrum of benefits of antipsychotic drugs. Even with good adherence, patients can face incomplete symptom response (including refractory psychosis) and a high comorbidity burden (including the metabolic syndrome) that must be managed.

a. First-episode patients:

In a recent survey of 113 practitioners, less than one third were able to correctly diagnose schizophrenia based on a vignette of a prototypical first-episode patient who had comorbid substance use. Approximately 54% of practitioners surveyed reported that non-adherence to treatment is the most important barrier in treating this patient. Despite guideline recommendations to treat patients for at least one year following a first-episode of schizophrenia, in a typical cohort of first-episode patients less than 50% of first-episode patients are sufficiently adherent during the first 12 months of treatment, suggesting the potential for improvement on the management of non-adherence.

b. Multi-episode (chronic) patients:

41% of patients in the CATIE sample were diagnosed with the metabolic syndrome, and this cohort had a greatly increased 10-year cardiovascular risk estimate compared to the normal population. Since the CATIE cohort is representative of the typical patient with chronic schizophrenia in the US, the cardiovascular risk factor findings suggest the need for psychiatrists to be able to recognize and manage metabolic problems associated with antipsychotics and schizophrenia. Since a significant minority of patients with schizophrenia will be insufficiently treated with first-line antipsychotics monotherapy, psychiatrists should be able to offer rational antipsychotic combinations and clozapine. Psychiatrists in the US are under prescribing clozapine, leading the authors of CATIE to recommend the establishment of clozapine clinics where clozapine can be prescribed competently and responsibly.

Learning ObjectivesUpon completion of this activity, participants should be able to:

Differentiate initial treatment goals for patients with first-episode schizophrenia

Discuss a reasoned work-up to exclude medical causes of psychosis

Examine key factors contributing to poor adherence in first-episode and chronic patients

Manage long-term side effects associated with antipsychotics

Determine strategies to address treatment-refractory positive symptoms including the use of clozapine

Describe the role of psychosocial strategies in enhancing treatment response and adherence

AgendaSaturday, October 18, 2008

7:00AM – 7:30AM Registration & Continental Breakfast

7:30AM – 7:45AM Welcome and Opening Remarks/Pre-Activity Questions

7:45AM – 8:35AM Process Improvement in the Care of Patients with Schizophrenia

8:35AM – 9:25AM Case Conference: First-Episode Patients

9:25AM – 9:40AM Break

9:40AM – 10:30AM First-Episode Schizophrenia: Initial Treatment Goals

10:30AM – 11:20AM Increasing Patient-Provider Alliance and Treatment Adherence in First-Episode Schizophrenia

11:20AM – 12:20PM Lunch

12:20PM – 1:10PM Case Conference: Chronic Patients

1:10PM – 2:00PM Long-Term Antipsychotic Side Effect Management

2:00PM – 2:50PM Treatment-Refractory Schizophrenia

2:50PM – 3:05PM Break

3:05PM – 3:55PM Increasing Patient-Provider Alliance and Treatment Adherence in Chronic Schizophrenia

3:55PM – 4:10PM Post Activity Questions

4:10PM – 5:00PM Panel Discussion

FacultyFaculty for this program includes:

Oliver Freudenreich, MD
Director, First Episode and Early Psychosis Program
Massachusetts General Hospital
Lisa D. Dixon, MD
Professor of Psychiatry
University of Maryland School of Medicine
Director, Division of Services Research, and Associate Director for Research
VA Capitol Health Care Network Mental Illness Research Education and Clinical Center
David C. Henderson, MD
Associate Psychiatrist and Director, Schizophrenia Diabetes and Weight Reduction Research Program, Massachusetts General Hospital
Diana O. Perkins, MD, MPH
Professor of Psychiatry, University of North Carolina Chapel Hill School of Medicine
Robert J. Birnbaum, MD, PhD
Executive Director, Postgraduate Medical Education, Massachusetts General Hospital
Facility InformationMGH Simches Research Building

Starr Center, 2nd Floor

185 Cambridge Street

Boston, MA 02114

AccreditationTarget Audience
The target audience for this event is psychiatrists, general and family practitioners, other physicians, and nurses.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Elsevier Office of Continuing Medical Education (EOCME) and Reed Medical Education. The EOCME is accredited by the ACCME to provide continuing medical education (CME) for physicians.

Credit Designation
The EOCME designates this continuing medical education activity for a maximum of 8 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosure
As a sponsor accredited by the ACCME, it is the policy of the EOCME to require the disclosure of anyone who is in a position to control the content of an educational activity. All relevant financial relationships with any commercial interests and/or manufacturers must be disclosed to participants at the beginning of each activity. Full faculty disclosures will be made available on the date of this activity.

This program is supported by educational grants from Eli Lilly & Company; Bristol-Myers Squibb; and Pfizer.

Our evidence-based curriculum is supported by educational grants from: