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Patient Scenario 3 - Tackling the Chronic Phase
Footage from the Janssen EMEA Medical Education Satellite Symposium, 26th ECNP Congress, October 2013
Philip McGuire asks why adherent patient do not respond to adequate doses of a drug. The neurological basis for this is unclear. He discusses a PET study on dopamine function in patients that do vs those that do not respond to treatment. Differences exists in level of upregulation of dopamine. Non responding subgroup showed normal dopamine levels, explaining why treatment is not effective. Similarly cortical glutamate function was measured and showed a stronger elevation in glutamate function in non-responders. What causes the resistance? Early studies show indicate the combination of the two abnormalities, data shows. These measurements may be used to stratify patients, predicting the response to D2 blockade.
Silvana Galderisi argued that response to treatment was very variable in heterogenic group. Also differences in response of responding patients are seen, some not reaching the mark ‘recovery’, despite remission. Half of chronic patients do not fully recover and the degree of improvement varies. Different domains of negative symptoms influence different aspects of the patients' functioning in daily life - important to consider in evaluations.
Andreas Schreiner asks what do guidelines recommend? Review diagnosis, engage non-pharmacological treatment, explore other causes of non-response. Resistance or pseudo-resistance may be caused by adherence. Dutch guidelines advise to consider long-acting medication, before switching to other medication. These guidelines also state we should ascertain adherence to medication before switching to (other) oral medication.
Martin Lambert notes that only 4-8% of patients have ever received an evidence based treatment. This should be considered. Patients must comply with treatment medication. Many are not; about 20% take medication irregularly. People prefer to stay on depot medication, especially when they are stable using this. Integrated care system has lowered the involuntary hospital admission by a factor 6. Even chronic patients can show full recovery, as 25% of chronic patients (some already for 10 years) have fully recovered using the integrated care system.
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.