John M. Kane, MD, provides several take-home messages regarding the optimal management of schizophrenia given his understanding of the current treatment landscape.
John M. Kane, MD: It’s very important that clinicians are aware of the advantages of the different long-acting formulations. And I think there are many clinicians in other areas of medicine who wish they had the ability to give their medicine by injection once a month or every 2 months or every 3 months, and they would be excited about that. It’s unfortunate that we don’t all share the same excitement that we’re fortunate to have these opportunities, because it makes it so much easier for a patient to get an injection periodically rather than to take pills every day.
In terms of potential embarrassment, if I’m in college and I have a roommate and I’m taking pills every day and my roommate says, 'John what’s wrong?,' maybe I don’t want to tell him that I have schizophrenia or whatever it is. I hope someday there will be no stigma associated with mental illness, but right now there might be. So perhaps I’d be more comfortable just going to a clinic periodically or to my doctor’s office and getting an injection and nobody has to know about that. Or if I go on vacation, I don’t have to worry about going to a pharmacy in another city, but I know I got my injection, I don’t have to worry.
It’s extremely important for us to recognize how critical it is to prevent relapse and rehospitalization with all of the consequences that those events can have on the patients’ life, the families’ life, their social and vocational adjustment on society, on cost of care, and all of those things.
We know that these medications can be highly efficacious in preventing relapse. But we also know that many people have trouble taking medication on a regular basis over the long term, whether it’s a medical illness or a psychiatric illness. So we need to take that into consideration and recognize that’s human nature. We need to help the patient get the benefit of the medication that we know can be helpful. And we’re fortunate in that we have an array of options. We have a number of long-acting injectable formulations, different medicines, and different injection intervals that we can offer to patients. But I think it has to be done in the right way.
We have to destigmatize nonadherence. We have to normalize nonadherence, explain that it’s human nature, that it doesn’t mean you’re a bad patient or a bad person. But we just want to help you get the benefit of the medication. It’s not a punishment. It’s really a way to help you get the benefit of the medicine. We want to work with you to achieve that. I think we need to help educate the patients, the families, the clinical team, everybody, as to what the potential advantages are of this approach and then take advantage of that opportunity. And set it up much more as an expectation rather than it’s the exception. So rather than ask, 'Why should we put this patient on a long-acting injectable formulation?,' I would rather ask, 'Why shouldn’t we? What’s the reason not to? If we see these advantages, then why wouldn’t we encourage this routinely?' And I think that’s the opportunity that we have.