Adult/Adolescent Schizophrenia

Adult Schizophrenia

Schizophrenia is characterized by chronic or recurrent psychosis and is commonly associated with impairments in social and occupational functioning.1
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PATIENTS WITH SCHIZOPHRENIA EXPERIENCE1:
  • Positive symptoms such as hallucinations or delusions
  • Negative symptoms such as a flat affect or poverty of speech
  • Disorganized speech
  • Impairments in cognition, including: attention, memory, and executive function
  • A diagnosis of schizophrenia is based on the presence of such symptoms, coupled with social or occupational dysfunction, for at least six months in the absence of another diagnosis that would account for these symptoms

Schizophrenia Epidemiology
The prevalence of schizophrenia approaches 1% internationally.2
The incidence (the number of new cases annually) is about 1.5 per 10,000 people.2

Modal age of onset of schizophrenia is between 18 and 25 for men and between 25 and 35 for women, with a second peak occurring around menopause.3 

The prognosis of schizophrenia is worse in men.4,5

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Metabolic Comorbidities

Compared with the general population men and women with schizophrenia are at a greater risk for metabolic syndrome.7
Lifestyle and genetic factors contribute to metabolic risk independent of risk associated with antipsychotic treatment.6

RAISE Study 2-Year Outcomes8

Results
Duration of untreated psychosis (<74 weeks) was a significant moderator of the treatment effect on Total Quality of Life Scale (ES 0.54) and PANSS scores (ES 0.42) over time. 
Navigate-assigned patients had several positive significant differences in outcomes vs regular care:
  • Remained in treatment longer
  • More likely to have received outpatient services
  • Greater improvement in quality of life over 2 years (p<0.02)
  • More improvements were seen in the interpersonal and intrapsychic foundations (sense of purpose, motivation, curiosity, & emotional engagement) as well as engagements with common objects & activities
  • Greater number of participants working or in school (p<0.05)
  • Greater improvement on the PANSS (p<0.02) and Calgary Depression Scale (p<0.04)
  • Reduced rate of hospitalization (p=NS)

The Recovery After an Initial Schizophrenia Episode (RAISE) Study8

RAISE Background
RAISE aims to develop, test, and implement person-centered, integrated treatment approaches for first-episode psychosis that promote symptomatic and functional recovery


Assigned to “Navigate vs Regular Care”

Assessment Scales: Total Score of Heinrichs-Carpenter QOL scale assessing purpose, motivation, emotional & social interactions, role functioning and engagement in regular activities.

RAISE Study Arms
NAVIGATE-FOUR CORE INTERVENTIONS:
  1. Personalized medication management (assisted by COMPASS, a secure, web-based decision support system developed for RAISE Early Treatment Program)
  2. Family psychoeducation
  3. Resilience-focused individual therapy
  4. Supported employment and education (SEE)
REGULAR CARE:
  1. “Treatment as Usual”: Psychosis treatment determined by clinician choice and service availability.
  2. Community care sites received no additional training or supervision except for guidance regarding subject recruitment, retention, and collection of research data.
​Heinrichs-Carpenter Quality of Life (QLS) Total Score and PANSS Total Score: Effects of Shorter or Longer Duration of Untreated Psychosis (DUP) Based on a Model With Square Root Transformation of Monthsa
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a In the model, DUP and DUP by square root of time by treatment terms were included as covariates. The DUP by square root of time term was found not to be significant for either outcome. DUP=Duration of Untreated Psychosis; QLS=Quality of Life Score; PANSS=Positive and Negative Syndrome Scale; REG=Regular Care; NAV=NAVIGATE.
bDUP by treatment by square root of time interaction, p=0.003. cDUP by treatment by square root of time interaction, p=0.043.

References: 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA; 2013. 2. McGrath J, et al. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30:67. 3. American Psychiatric Association. Diagnostic and Statistical Manual, Fourth Edition Text Revision (DSM-IV TR), American Psychiatric Publishing, Arlington, VA; 2000. 4. Grossman LS, et al. Sex differences in schizophrenia and other psychotic disorders: a 20-year longitudinal study of psychosis and recovery. Compr Psychiatry. 2008;49:523. 5. Usall J, et al. Gender differences and outcome in schizophrenia: a 2-year follow-up study in a large community sample. Eur Psychiatry. 2003;18:282. 6. Vancampfort D, et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders,bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry. 2015;14(3):339. 7. McEvoy JP, et al. Prevalence of the Metabolic Syndrome in Patients With Schizophrenia: Baseline Results From the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial and Comparison With National Estimates From NHANES III. Schizophr Res. 2005;80(1):19. 8. Kane J, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. Am J Psychiatry. 2016;173(4):362.

Adolescent Schizophrenia