John J. Miller, MD: Our objective with this segment is to discuss the current standard of care in schizophrenia, focusing on the available pharmacotherapy agents, their efficacy and adverse effect profiles, and unique patient considerations for treatment choice. Sandy, let’s begin this section with you. What are some goals of therapy in the typical journey of a person with schizophrenia? And how would you define achieving stability? Once someone’s established in treatment and it’s been ongoing, what does that ideal treatment plan include at 2, 3, 4, or 5 years out?

Sandy Dimiterchik: One of the first terms I learned was recovery. Some people don’t like the term because it hasn’t been defined in a way that they think is realistic; you will have schizophrenia for the rest of your life. But we use a blue book in our support groups, and there’s a chapter on aspects of recovery. The goal, according to the Schizophrenia & Psychosis Action Alliance, is to help people to function to the maximum extent, given that everybody’s an individual. And there’s always going to be reality checking; that’s going to be a part of life. Stable disease, that’s also another difficult thing to define because I know when I first [received a diagnosis of] schizophrenia, I’d [received a diagnosis of] bipolar [disorder] 10 years earlier. And the [physician] kept upping my dosage so that I wouldn’t hear voices or be paranoid or have suicidal ideation, but it was to the extent that my parents finally went to him because all I was doing was sleeping. And they said, “This isn’t quality of life.” But he was concerned about a recurrence. And I know [physicians] do it differently now than back in 2008. There’s been a lot done to improve the quality of care. But if you’re stable, it’s being able to do different activities, although each type of activity depends on the person. [In] optimal treatment, you would hope to see somebody who’s able to move or volunteer, maybe go back to school, maybe work part-time. And therapy is so important. My therapist told me, “Sandy, even if you get the job, you won’t be able to keep it unless you learn these social skills, and you need to learn to do things by baby steps instead of leaps and bounds.”

John J. Miller, MD:Good points. And yes, the spectrum is large. I have several patients with schizophrenia who work full-time jobs and live independently, so the spectrum is wide and every person will have their own point where they feel they’ve recovered. The challenge for us is helping them get there.

Transcript edited for clarity.