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Patient Scenario 2 - Defying the Cycle of Relapse
Footage from the Janssen EMEA Medical Education Satellite Symposium, 26th ECNP Congress, October 2013
Philip McGuire argues that relapse risks increase significantly and rapidly upon discontinuation of anti-psychotics. Also treatment interruption, e.g. for one month, may cause similar effects. The dopamine system is likely involved in this effect. Neuroimaging studies show sensitivity to relapse is related to sensitivity of the dopamine system to a stimulus.
Silvana Galderisi discusses why relapse happens so often. She promotes functional long term effective treatment. But how? Discontinuation of the use of anti-psychotics should not be part of clinical care and use of placebos in clinical trials should also be considered carefully. There should be a focus on patient adherence, integrated care programs, and alternative (additional) forms of intervention.
Andreas Schreiner states patients can respond well after relapse. A subpopulation (16% in study shown) however does not respond anymore after a single relapse. In this light, considering long acting anti-psychotic treatment already in first episode patients, also makes sense. He discusses discrepancies in literature on this subject, and the strong effect of study design on the outcome.
Martin Lambert talks of the overlap of relapse, disease chronicity and severe mental illness and the fact that many of our mental health systems are unable to treat properly. As a consequence such patients have poor access to psychiatric and somatic care. A different integrative care system set up for this specific subgroup of psychotic patients is discussed. Importantly, shared decision making should be a long-term process to get the maximum effect.
Discussion follows these presentations.
Footage comes from the Janssen EMEA Medical Education Satellite Symposium, 26th ECNP Congress, October 2013 Speakers: Chair/Moderator: W Wolfgang Fleischhacker, Austria Panel: Philip McGuire, UK Silvana Galderisi, Italy Martin Lambert, Germany Andreas Schreiner, Germany.