Unmet Needs and the Importance of Social Support in Schizophrenia

Treatment adherence is a big challenge for patients with schizophrenia, as is the appropriate use of clozapine in treatment-resistant schizophrenia, said Megan Ehret, PharmD, MS, BCPP, professor and codirector of the Mental Health Program, University of Maryland, School of Pharmacy. She also noted that telehealth hasn’t been as helpful for treating patients with schizophrenia as it has in other areas of care.

Ehret discussed schizophrenia management strategies in a session at AMCP Nexus: The Academy of Managed Care Pharmacy Nexus, held October 14-17 in Las Vegas, Nevada.

This transcript has been lightly edited for clarity.

Transcript

What are the biggest unmet needs remaining in schizophrenia treatment that need to be addressed?

I would put them into a couple of different buckets. One, treatment adherence. There are a lot of patients that, unfortunately, don't have the insight or judgment into the illness or the support system necessary to stay on medications. We know that medications increase the prognosis and quality of life of patients. So, identification of that is very important.

A second unmet need is the identification of treatment-resistant or difficult-to-treat schizophrenia. Many providers continue to try different medications and maybe don't make that particular diagnosis, for which we know clozapine is the gold standard. So, an unmet need is the utilization of clozapine for our treatment-resistant schizophrenia.

And then, ultimately, just awareness and access for these patients to care. It became very challenging post-pandemic to continue to engage a lot with this potential population of patients as different socioeconomics and social determinants of health changed the landscape; with many changes post-pandemic: telehealth, ability to access medications, changes in pharmacy, closures, and all kinds of different things that I think just really are an unmet need for many of our patients.

A lot of areas in health care have seen a lot of benefit from the expansion of telehealth. Is this one area where telehealth hasn't been as beneficial?

Post-pandemic, we saw an increase in patients using telehealth, but unfortunately, it probably isn't a great process for everyone because not everyone has the same access to smartphones or the internet or things of that sort. When our patients are homeless or if they're in and out of different locations and living in transitions of care, it can be very hard to track down patients. This makes it more challenging, and when treatment adherence is so important, that engagement with the provider can be ideal.

Many of our adverse effects may require some sort of in-person monitoring, whether that be labs or movement disorder scales or administration of long-acting injectables. Those are all kind of in-person things. It's very hard to have a patient with a blood pressure cuff, a scale, and internet access and be on time to meet and say, “Here are all the things I need you to do while we're on this telehealth appointment.” While it's ideal, it does give us some access to the patients; I think there's a population where it goes unmet.

What role does a social support system play in treatment success for patients with schizophrenia?

Social supports are very important. Initial social supports to engage in treatment can be ideal. It can be life changing, if you have the family support or the social aspect of that support, it can be life changing versus dealing with it sort of on your own.

The challenge is that so many people in that social support get burnt out, potentially, over time with that, and so that continued engagement is so very important.