Diagnostic Challenges With Schizophrenia Delay Important Treatment

As schizophrenia develops, the symptoms can mimic other conditions, which causes a delay in treatment, which negatively impacts the prognosis of the illness, said Megan Ehret, PharmD, MS, BCPP, professor and codirector of the Mental Health Program, University of Maryland, School of Pharmacy.

Ehret discussed schizophrenia management strategies in a session at AMCP Nexus, held October 14-17 in Las Vegas, Nevada.

This transcript has been lightly edited for clarity.

Transcript

What's the diagnosis like for schizophrenia? Does it get diagnosed in a timely way? Are there challenges that might delay a diagnosis?

Schizophrenia is an illness that occurs typically in the early 20s. Usually by late 20s or beginning of the 30s that diagnosis has presented itself. Unfortunately, the way that the illness presents itself, we may not diagnose in an efficient manner. Some of the early symptoms of schizophrenia may mimic what you might think of as depression—so a lack of affect or emotion. There might be aggression and some of that, like hallucinations and delusions, which we think are really the positive symptoms of schizophrenia, may not present themselves in an immediate fashion, and so there can be a delay in an appropriate diagnosis.

Additionally, there's a lot of confusion, potentially, [with] bipolar disorder, which can have similar symptoms of schizophrenia. So, you might see someone who has some manic symptoms, grandiosity, racing thoughts, or risk taking, and in that there is some positive hallucinations or delusions. And so it can be a little bit hard to sort of tease out the 2 illnesses, especially during the early onset.

And many times, patients may not present [for diagnosis], because they don't have an acceptance that there may be a mental health concern. And then also there are a lot of social determinants of health that also would limit diagnosis. Perhaps there may be lack of access to mental health care, or there may be substance use disorders also ongoing, which can have some similar symptoms, as well, that may delay our diagnosing of the illness.

Considering schizophrenia might be initially diagnosed as something else, like bipolar disorder or depression, how does that impact treatment plans and accurately treating schizophrenia?

We know that early and correct treatment helps the prognosis of the illness.

As you heard throughout the presentation with Bethany's story and how she talked about her own history with schizophrenia, an accurate diagnosis and an accurate treatment early on really sets someone up for a better quality of life. So, if we don't have the right treatment plan—and there are vast differences in how we treat depression vs bipolar versus schizophrenia—and we’re using the incorrect medication, while not ultimately harmful to the patient themselves, it can actually make the prognosis worse. Because you're not ultimately treating the symptoms adequately and getting the patient into some of the psychosocial treatments they might also need in schizophrenia: the cognitive therapy and the social supports. Those sorts of aspects may get missed long term when we're not appropriately treating schizophrenia.