Unmet needs and the importance of social support in schizophrenia

Adherence to treatment is a big problem for patients with schizophrenia“As well as the appropriate use of clozapine for treatment-resistant schizophrenia,” said Megan Ehret, PharmD, MS, BCPP, professor and co-director of the mental health program at the University of Maryland School of Pharmacy. She also noted that telemedicine is not as useful for treating patients with schizophrenia as it is in other areas of health care.

Ehret discussed treatment strategies for schizophrenia in a session at AMCP Nexus: Pharmacy Nexus Managed Care Academyheld October 14-17 in Las Vegas, Nevada.

This transcript has been lightly edited for clarity.

Transcript

What are the greatest unmet needs in schizophrenia treatment that need to be addressed?

I would put them in several different buckets. First, adherence to treatment. There are many patients who unfortunately do not have the understanding or judgment of the disease or the support system needed to continue taking their medications. We know that medications improve patients’ prognosis and quality of life. So identifying this is very important.

A second unmet need is the identification of treatment-resistant or difficult-to-treat schizophrenia. Many doctors continue to try different medications and may not make a specific diagnosis for which we know clozapine is the gold standard. Thus, an unmet need is the use of clozapine to treat our treatment-resistant schizophrenia.

And then ultimately just awareness and access to care for these patients. Since the pandemic, it has become very difficult to continue to actively engage with this potential patient population as various socioeconomic factors and social determinants of health have changed the landscape; with many changes since the pandemic: telehealth, ability to access medications, changes in pharmacies, closures and a lot of other things that I think are really an unmet need for a lot of our patients.

Many areas of healthcare have benefited greatly from the expansion of telehealth. Is this the only area where telehealth hasn’t been as beneficial?

Since the pandemic, we’ve seen an increase in patients using telehealth, but unfortunately, it’s probably not the best process for everyone because not everyone has the same access to smartphones or the internet or anything like that. When our patients are homeless, or if they are in and out of different locations and living in respite care, tracking down patients can be very difficult. This makes it challenging, and when medication adherence is so important, communication with a provider can be ideal.

Many of our side effects may require some kind of in-person monitoring, whether through laboratory testing, movement disorder scales, or long-acting injectable medications. These are all personal things. It’s very difficult to have a patient with a blood pressure cuff and a scale and access to the Internet and show up on time for an appointment and say, “Here’s all I need you to do while we’re on a telemedicine appointment.” While this is ideal, it does give us some access to patients; I think there is a population that remains dissatisfied with this.

What role does the social support system play in the success of treatment for patients with schizophrenia?

Social support is very important. Initial social support for participation in treatment may be ideal. It can be life changing if you have family support or the social aspect of that support can be life changing rather than having to deal with it on your own.

The problem is that so many people who receive this social support potentially burn out over time because of it, and so ongoing engagement is very important.