Schizophrenia a Medication Challenge

By SHARMA HOWARD GATEHOUSE NEWS SERVICE

Of all the mental illnesses, schizophrenia has proven to be the most recalcitrant in terms of finding drugs that have good efficacy, as well as minimal side effects. It also is perhaps the most devastating mental illness when it comes to public perception and stigma.

"It’s one of the ones that psychiatry has made big advances in, but we’re not that good at yet. We’re darn good at depression, and pretty good at bipolar. We’re an awful lot better at treating it than we were 50 years ago," said Dr. Brian Benton, medical director of psychiatric services at The William W. Backus Hospital in Norwich, Conn.

A new drug treatment is available to treat schizophrenia: Invega, released in January by Janssen L.P., a New Jersey-based pharmaceutical company.

So far, Benton has seen the drug well-tolerated by his patients. He said it has the advantage of producing fewer side effects, interacts less with other medications and needs to be taken only once per day.

"It’s an improvement over other meds, but it still has difficult side effects," Benton said. "We still do not have a medication that doesn’t cause the risk of tardive dyskinesia – the newer medication a lot less, but it’s still a risk."

Serious side effects

Tardive dyskinesia can be a serious, sometimes permanent side effect linked to many neuroleptic medications used to treat psychiatric illnesses. Dose and duration contribute to the likelihood of developing symptoms, which include uncontrollable movements of the face, tongue and other parts of the body.

And it’s ironic, Benton said, one of the older medicines used to treat schizophrenia – Clozaril – still is considered the "gold standard." It usually works when all else fails, he said, but unfortunately its side effects aren’t generally well-tolerated.

But medication, according to mental-health professionals, is only one part of the equation in successfully treating an individual with schizophrenia.

"There’s no doubt that the medication options for people with mental illness, especially schizophrenia, is only part of the challenge," said Dr. James O’Dea, clinical psychologist and administrative director of the department of psychiatric services at Backus. "When someone begins to exhibit the symptoms, this almost by definition becomes a family issue."

That’s because the illness usually becomes symptomatic in young adulthood – ages 18-25.

"It’s almost always going to have effects for a person’s family. One of the things so critical is to do some early intervention," O’Dea said.

Now, mental health professionals are encouraging people to be alert to "soft symptoms" as early as grade school.

"This is the odd or unusual kid on the sidelines, perhaps doesn’t get involved as much," Benton said. "People can be very bright that get this illness."

A more positive outcome can be gained all around by early intervention in a multi-pronged approach of medication and therapy.

Finding the right medication, which for psychiatric illness can be a difficult time of trial and error, is crucial, Benton stressed. Research shows early treatment increases the prognosis.

"You want to find it as soon as you can and get them on treatment," Benton said. "The more episodes of severe psychosis, the worse it gets. They think the more severe episodes you have, you don’t come back as good. That’s true of all mental illnesses."

"A really holistic approach is needed. For some people it’s very challenging – they go through so many trials and errors to find the right treatment, they forget about the fact that recovery requires a broad approach," said Kate Mattias, executive director of the National Alliance on Mental Illness in Connecticut.

Degrees of symptoms

Yet as challenging as schizophrenia can be, it is important to realize like many illnesses, it presents itself in a spectrum, with degrees of severity in symptoms, Benton said.

And that’s why, O’Dea said, individuals and families get therapy and join support groups, so they can manage the illness and understand it.

"It’s so very important that individuals with the illness and their family get education about how the illness will affect their lives, which is important because of the stigma associated with having mental illness," O’Dea said, crediting inaccurate portrayals of schizophrenia, as well as prejudice found in the media.

"Absent education, people may start to feel overwhelmed. We want people to feel optimistic and hopeful about recovery."

"There’s an inordinate amount of stigma," Mattias said. "The diagnosis isn’t well understood in the population. I think that the common public media images tend to frame the picture of an individual with schizophrenia as scary, violent, very disturbed, with a very refractory illness that can’t be treated successfully with medication. That’s all myth, and very untrue."

In fact, Benton estimates 80 percent to 90 percent of people with schizophrenia will function well – with 80 percent participating in the community independently.

"Many people with this illness can go on to fulfilling adult and interpersonal relationships, and employment and leisure and recreational activities," O’Dea said.