- Email: [email protected]
C.02.01 Efficacy and tolerability of antipsychotic treatment
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C.02. Optimizing care for patient-centred outcomes in schizophrenia
C.01.05 Personalised medicine: a psychopharmacological perspective D. Stein1 ° 1 University of Cape Town, Department of Psychiatry and Mental Health Observatory 7925, Cape Town, South Africa Previously, psychiatric drugs have been discovered serendipitously, with clinicians having limited information about mechanisms of action (MoAs) and with knowledge of specific benefits only emerging long after approval. In the future, advances in pharmaceutical discovery, as well as in disease mechanisms, may provide a shorter path towards using psychotropic agents in a more selective way, so achieving personalised medicine in psychiatry. Here we review current perspectives on achievements in this field and define areas for improvement. There is a wealth of information related to recently approved antidepressant agents, which has either been made generally available at the time of approval or relatively soon after from a range of sources. Firstly, large pivotal randomised controlled trials have been undertaken. Secondly, significant knowledge about the MoA may have been garnered from laboratory and human studies. Thirdly, there may be data that link the underlying MoA with the clinical benefits of the agent. At the same time, barriers remain before personalised medicine is a reality in psychiatry. Although approaches such as The Research Domain Criteria have been initiated, drug approvals are based on the heterogeneous Diagnostic and Statistical Manual of Mental Disorders criteria for diagnosis. Moreover, although biological psychiatry and the human genome project have emphasised inter-individual variation, most work on biomarkers and pharmacogenomics has not yet crossed from the laboratory into the clinic. There is also an ongoing need for data on the relationship between the MoA and specific benefits of psychotropics for particular groups. Disclosure statement: In the past 3 years, Dr Stein has received research grants and/or consultancy honoraria from AMBRF, Biocodex, Cipla, Lundbeck, National Responsible Gambling Foundation, Novartis, Servier, and Sun.
C.01.06 Cognitive dysfunction in depression: characteristics and burden B. Baune1 ° 1 University of Adelaide, Discipline of Psychiatry, Adelaide, Australia Clinical depression is often associated with significant impairments in multiple domains of neurocognitive function during the acute episode and persists in one-third of patients after clinical recovery of typical depressive symptoms. Subgroups of patients show neurocognitive deficits up to 2 years after an acute mood disorder episode. Research suggests that ongoing cognitive impairment may contribute to the functional impairment frequently observed in patients with episodic and relapsing depression. Specifically, in a significant number of patients, poor reintegration at work occurs after a depressive episode. Moreover, a close association between cognitive dysfunction, reduced general function, productivity and employment status has been reported. This presentation will provide an overview of this clinically relevant area by characterising the clinical significance of cognitive dysfunction in depression, outlining its impact on patient
function and discussing treatment opportunities that target cognitive domains. In addition, since depression is frequently characterised by an episodic nature, cognitive function during acute symptoms and remission will be explored. Other clinical characteristics, such as the relationship between diagnosis (bipolar and unipolar depression) and cognitive function, will also be briefly reviewed. Although increasing age is frequently associated with poor cognitive function, studies indicate that even young patients suffering from depression may already be affected by poorer cognitive function. The clinical relevance of cognitive dysfunction in depression is highlighted by the frequently observed general, social and occupational functional impairments in patients with mood disorders. Disclosure statement: Professor Baune is a member of advisory boards and/or has given presentations for the following companies: AstraZeneca, Lundbeck, Pfizer, Servier, Bristol-Myers Squibb and Wyeth. Professor Baune receives funding from the National Health and Medical Research Council (NHMRC), Australia.
C.02. Optimizing care for patient-centred outcomes in schizophrenia C.02.01 Efficacy and tolerability of antipsychotic treatment J. Peuskens1 ° 1 UPC KU Leuven, Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium Schizophrenia is a lifelong illness requiring long-term treatment. The aims of pharmacological treatment are to control acute symptoms and improve outcomes such as patient functioning and quality of life [1]. Both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are effective in addressing positive symptoms of schizophrenia while negative symptoms and cognitive impairment remain critical unmet treatment needs. As a treatment class, FGAs are associated with more extrapyramidal motor side effects and tardive dyskinesia than SGAs, whereas SGAs are associated with more weight gain and cardiometabolic adverse effects [2]. However, SGAs do not represent a homogenous class of drugs and certain side effects cannot be considered common for the whole group of SGAs [3]. Selection of antipsychotic medications should be based on short-term goals as well as long-term objectives of maintaining symptomatic remission, supporting psychosocial integration and improving quality of life through a balance of effective symptom control and adequate tolerability. Therefore, assessment of the long-term safety and tolerability of antipsychotics is particularly important when initiating therapy. Recent large randomized controlled clinical trials (RCTs) and meta-analyses have produced inconsistent findings concerning the comparative efficacy and tolerability of antipsychotic treatments [2,3]. However, due to their design, RCTs can favour enrolment of highly adherent patients with lower illness severity compared with those routinely seen in practice. Suggesting careful analysis of methodologies and data interpretation may be required when considering treatment options. For each patient, a treatment plan must be formulated and implemented taking into account past and current treatments and response to them.
C.02. Optimizing care for patient-centred outcomes in schizophrenia References [1] Kasper S. Optimisation of long-term treatment in schizophrenia: treating the true spectrum of symptoms. 2006. Eur. Neuropsychopharmacol. 16(Suppl 3, S135-S141. [2] Leucht S., Corves C., Arbter D., Engel R.R., Li C., Davis J.M. Secondgeneration versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. 2008. Lancet 373: 31−41. [3] Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lassig B, Salanti G, Davis JM. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments metaanalysis. 2013. Lancet. 382(9896): 951–962. Disclosure statement: JP has received speaker’s honoraria and research support from, and was part of advisory boards for AstraZeneca, BristolMyers Squibb, Eli Lilly, Janssen-Cilag, and Lundbeck. This abstract is financially supported by Janssen
C.02.02 Patient experience and satisfaction S. Heres1 ° 1 Technische Universitaet Muenchen, Department of Psychiatry, Munich, Germany The onset of schizophrenia typically occurs during late adolescence or early adulthood. As a result, the impact on a patient’s ability to develop social skills and build personal relationships is considerable, placing a heavy burden on patients, their families and carers. Treatment goals in schizophrenia have evolved from focusing on control of positive symptoms to a more comprehensive and multidisciplinary approach where outcomes are better aligned with patient needs [1]. Treatment priorities for patients with schizophrenia may differ from those of healthcare professionals (HCPs). For patients, the ability to perform social and daily activities is an important treatment outcome [1]. Patients who experience problematic side effects with their medication are more likely to develop negative attitudes towards treatment due to low treatment satisfaction, often leading to adherence problems [2]. Non-adherence to antipsychotic treatment can exacerbate the illness. A number of nonpharmacological and pharmacological approaches exist to address adherence issues, including long-acting injectable antipsychotic therapies to ensure delivery of medication. However, negative attitudes of HCPs towards these formulations may influence prescribing decisions [3]. An effective therapeutic alliance is a key aspect in patient satisfaction [3]. Shared decision-making is particularly important to ensure that patients are engaged in their treatment plan. Overall, the aims are to empower psychiatrists to lead better negotiations with their patients, to empower patients to assist them in increasing their negotiation skills and defining their needs and to empower carers/families to understand better the mental healthcare system and to assist their loved ones in understanding their treatment preferences. References [1] Harvey PD, Green MF, Keefe RS, Velligan DI. Cognitive functioning in schizophrenia: a consensus statement on its role in the definition and evaluation of effective treatments for the illness. 2004. J Clin Psychiatry. 65:361–372. [2] Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP; Expert Consensus Panel on Adherence Problems in Serious and Persistent Mental Illness. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. 2009. J Clin Psychiatry. 70 Suppl 4:1−46. [3] Kirschner M, Theodoridou A, Fusar-Poli P, Kaiser S, J¨ager M. Patients’ and clinicians’ attitude towards long-acting depot antipsychotics in
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subjects with a first episode of psychosis. 2013. Ther Adv Psychopharmacol. 3(2):89−99. Disclosure statement: This abstract is financially supported by an educational grant from Janssen.
C.02.03 Treatment optimization A. Schreiner1 ° 1 Janssen-Cilag EMA, Department of Medical and Scientific Affairs, Neuss, Germany Schizophrenia is a chronic, debilitating mental illness that negatively impacts upon many aspects of patients’ lives. Relapse prevention remains a key therapeutic aim, with antipsychotic medications the mainstay of schizophrenia treatment. There is increasing evidence to indicate that continuous antipsychotic treatment is associated with benefits beyond symptom control, such as improvements in functioning and health-related quality of life as well as a reduced risk of relapse [1]. This is particularly important as relapse duration is associated with loss of brain tissue over time [2]. Therefore, preventing relapse could provide a significant clinical benefit. Despite the benefits of continuous medication, discontinuation and frequent switching of antipsychotic treatments are common among patients with schizophrenia. Ensuring adherence to medication as prescribed is key in preventing relapse, and can be maximized using a range of pharmacological and psychosocial interventions. Amongst the antipsychotic treatment options, longacting antipsychotic therapies (LAT) can provide assured delivery and transparency of patients’ adherence to treatment. Studies have shown improved patient outcomes with LATs compared with oral medication which have been ascribed to improved adherence [3]. Furthermore, evidence suggests that LATs can help to minimize the time in a relapse state [2]. Strategies to optimize treatment therefore include individualization of medication selection and dose to maximize efficacy and minimize adverse effects along with utilization of LATs that eliminate the need for the patient to remember daily oral medication, and psychosocial approaches that emphasize the benefits of staying well. References [1] Ca˜nas F, Alptekin K, Azorin JM, Dubois V, Emsley R, Garc´ıa AG, Gorwood P, Haddad PM, Naber D, Olivares JM, Papageorgiou G, Roca M. Improving treatment adherence in your patients with schizophrenia: the STAY initiative. 2013. Clin Drug Investig. 33(2): 97–107. [2] Andreasen NC, Liu D, Ziebell S, Vora A, Ho BC. Relapse duration, treatment intensity, and brain tissue loss in schizophrenia: a prospective longitudinal MRI study. 2013. Am J Psychiatry. 170(6): 609−15. [3] Kishimoto T, Nitta M, Borenstein M, Kane JM, Correll CU. Longacting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. 2013. J Clin Psychiatry. 74(10): 957−65. Disclosure statement: AS is a full-time employee of Janssen-Cilag Medical & Scientific Affairs Europe, Middle East & Africa and is a shareholder of Johnson & Johnson.
C.02. Optimizing care for patient-centred outcomes in schizophrenia
C.01.05 Personalised medicine: a psychopharmacological perspective D. Stein1 ° 1 University of Cape Town, Department of Psychiatry and Mental Health Observatory 7925, Cape Town, South Africa Previously, psychiatric drugs have been discovered serendipitously, with clinicians having limited information about mechanisms of action (MoAs) and with knowledge of specific benefits only emerging long after approval. In the future, advances in pharmaceutical discovery, as well as in disease mechanisms, may provide a shorter path towards using psychotropic agents in a more selective way, so achieving personalised medicine in psychiatry. Here we review current perspectives on achievements in this field and define areas for improvement. There is a wealth of information related to recently approved antidepressant agents, which has either been made generally available at the time of approval or relatively soon after from a range of sources. Firstly, large pivotal randomised controlled trials have been undertaken. Secondly, significant knowledge about the MoA may have been garnered from laboratory and human studies. Thirdly, there may be data that link the underlying MoA with the clinical benefits of the agent. At the same time, barriers remain before personalised medicine is a reality in psychiatry. Although approaches such as The Research Domain Criteria have been initiated, drug approvals are based on the heterogeneous Diagnostic and Statistical Manual of Mental Disorders criteria for diagnosis. Moreover, although biological psychiatry and the human genome project have emphasised inter-individual variation, most work on biomarkers and pharmacogenomics has not yet crossed from the laboratory into the clinic. There is also an ongoing need for data on the relationship between the MoA and specific benefits of psychotropics for particular groups. Disclosure statement: In the past 3 years, Dr Stein has received research grants and/or consultancy honoraria from AMBRF, Biocodex, Cipla, Lundbeck, National Responsible Gambling Foundation, Novartis, Servier, and Sun.
C.01.06 Cognitive dysfunction in depression: characteristics and burden B. Baune1 ° 1 University of Adelaide, Discipline of Psychiatry, Adelaide, Australia Clinical depression is often associated with significant impairments in multiple domains of neurocognitive function during the acute episode and persists in one-third of patients after clinical recovery of typical depressive symptoms. Subgroups of patients show neurocognitive deficits up to 2 years after an acute mood disorder episode. Research suggests that ongoing cognitive impairment may contribute to the functional impairment frequently observed in patients with episodic and relapsing depression. Specifically, in a significant number of patients, poor reintegration at work occurs after a depressive episode. Moreover, a close association between cognitive dysfunction, reduced general function, productivity and employment status has been reported. This presentation will provide an overview of this clinically relevant area by characterising the clinical significance of cognitive dysfunction in depression, outlining its impact on patient
function and discussing treatment opportunities that target cognitive domains. In addition, since depression is frequently characterised by an episodic nature, cognitive function during acute symptoms and remission will be explored. Other clinical characteristics, such as the relationship between diagnosis (bipolar and unipolar depression) and cognitive function, will also be briefly reviewed. Although increasing age is frequently associated with poor cognitive function, studies indicate that even young patients suffering from depression may already be affected by poorer cognitive function. The clinical relevance of cognitive dysfunction in depression is highlighted by the frequently observed general, social and occupational functional impairments in patients with mood disorders. Disclosure statement: Professor Baune is a member of advisory boards and/or has given presentations for the following companies: AstraZeneca, Lundbeck, Pfizer, Servier, Bristol-Myers Squibb and Wyeth. Professor Baune receives funding from the National Health and Medical Research Council (NHMRC), Australia.
C.02. Optimizing care for patient-centred outcomes in schizophrenia C.02.01 Efficacy and tolerability of antipsychotic treatment J. Peuskens1 ° 1 UPC KU Leuven, Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium Schizophrenia is a lifelong illness requiring long-term treatment. The aims of pharmacological treatment are to control acute symptoms and improve outcomes such as patient functioning and quality of life [1]. Both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are effective in addressing positive symptoms of schizophrenia while negative symptoms and cognitive impairment remain critical unmet treatment needs. As a treatment class, FGAs are associated with more extrapyramidal motor side effects and tardive dyskinesia than SGAs, whereas SGAs are associated with more weight gain and cardiometabolic adverse effects [2]. However, SGAs do not represent a homogenous class of drugs and certain side effects cannot be considered common for the whole group of SGAs [3]. Selection of antipsychotic medications should be based on short-term goals as well as long-term objectives of maintaining symptomatic remission, supporting psychosocial integration and improving quality of life through a balance of effective symptom control and adequate tolerability. Therefore, assessment of the long-term safety and tolerability of antipsychotics is particularly important when initiating therapy. Recent large randomized controlled clinical trials (RCTs) and meta-analyses have produced inconsistent findings concerning the comparative efficacy and tolerability of antipsychotic treatments [2,3]. However, due to their design, RCTs can favour enrolment of highly adherent patients with lower illness severity compared with those routinely seen in practice. Suggesting careful analysis of methodologies and data interpretation may be required when considering treatment options. For each patient, a treatment plan must be formulated and implemented taking into account past and current treatments and response to them.
C.02. Optimizing care for patient-centred outcomes in schizophrenia References [1] Kasper S. Optimisation of long-term treatment in schizophrenia: treating the true spectrum of symptoms. 2006. Eur. Neuropsychopharmacol. 16(Suppl 3, S135-S141. [2] Leucht S., Corves C., Arbter D., Engel R.R., Li C., Davis J.M. Secondgeneration versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. 2008. Lancet 373: 31−41. [3] Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lassig B, Salanti G, Davis JM. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments metaanalysis. 2013. Lancet. 382(9896): 951–962. Disclosure statement: JP has received speaker’s honoraria and research support from, and was part of advisory boards for AstraZeneca, BristolMyers Squibb, Eli Lilly, Janssen-Cilag, and Lundbeck. This abstract is financially supported by Janssen
C.02.02 Patient experience and satisfaction S. Heres1 ° 1 Technische Universitaet Muenchen, Department of Psychiatry, Munich, Germany The onset of schizophrenia typically occurs during late adolescence or early adulthood. As a result, the impact on a patient’s ability to develop social skills and build personal relationships is considerable, placing a heavy burden on patients, their families and carers. Treatment goals in schizophrenia have evolved from focusing on control of positive symptoms to a more comprehensive and multidisciplinary approach where outcomes are better aligned with patient needs [1]. Treatment priorities for patients with schizophrenia may differ from those of healthcare professionals (HCPs). For patients, the ability to perform social and daily activities is an important treatment outcome [1]. Patients who experience problematic side effects with their medication are more likely to develop negative attitudes towards treatment due to low treatment satisfaction, often leading to adherence problems [2]. Non-adherence to antipsychotic treatment can exacerbate the illness. A number of nonpharmacological and pharmacological approaches exist to address adherence issues, including long-acting injectable antipsychotic therapies to ensure delivery of medication. However, negative attitudes of HCPs towards these formulations may influence prescribing decisions [3]. An effective therapeutic alliance is a key aspect in patient satisfaction [3]. Shared decision-making is particularly important to ensure that patients are engaged in their treatment plan. Overall, the aims are to empower psychiatrists to lead better negotiations with their patients, to empower patients to assist them in increasing their negotiation skills and defining their needs and to empower carers/families to understand better the mental healthcare system and to assist their loved ones in understanding their treatment preferences. References [1] Harvey PD, Green MF, Keefe RS, Velligan DI. Cognitive functioning in schizophrenia: a consensus statement on its role in the definition and evaluation of effective treatments for the illness. 2004. J Clin Psychiatry. 65:361–372. [2] Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP; Expert Consensus Panel on Adherence Problems in Serious and Persistent Mental Illness. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. 2009. J Clin Psychiatry. 70 Suppl 4:1−46. [3] Kirschner M, Theodoridou A, Fusar-Poli P, Kaiser S, J¨ager M. Patients’ and clinicians’ attitude towards long-acting depot antipsychotics in
S753
subjects with a first episode of psychosis. 2013. Ther Adv Psychopharmacol. 3(2):89−99. Disclosure statement: This abstract is financially supported by an educational grant from Janssen.
C.02.03 Treatment optimization A. Schreiner1 ° 1 Janssen-Cilag EMA, Department of Medical and Scientific Affairs, Neuss, Germany Schizophrenia is a chronic, debilitating mental illness that negatively impacts upon many aspects of patients’ lives. Relapse prevention remains a key therapeutic aim, with antipsychotic medications the mainstay of schizophrenia treatment. There is increasing evidence to indicate that continuous antipsychotic treatment is associated with benefits beyond symptom control, such as improvements in functioning and health-related quality of life as well as a reduced risk of relapse [1]. This is particularly important as relapse duration is associated with loss of brain tissue over time [2]. Therefore, preventing relapse could provide a significant clinical benefit. Despite the benefits of continuous medication, discontinuation and frequent switching of antipsychotic treatments are common among patients with schizophrenia. Ensuring adherence to medication as prescribed is key in preventing relapse, and can be maximized using a range of pharmacological and psychosocial interventions. Amongst the antipsychotic treatment options, longacting antipsychotic therapies (LAT) can provide assured delivery and transparency of patients’ adherence to treatment. Studies have shown improved patient outcomes with LATs compared with oral medication which have been ascribed to improved adherence [3]. Furthermore, evidence suggests that LATs can help to minimize the time in a relapse state [2]. Strategies to optimize treatment therefore include individualization of medication selection and dose to maximize efficacy and minimize adverse effects along with utilization of LATs that eliminate the need for the patient to remember daily oral medication, and psychosocial approaches that emphasize the benefits of staying well. References [1] Ca˜nas F, Alptekin K, Azorin JM, Dubois V, Emsley R, Garc´ıa AG, Gorwood P, Haddad PM, Naber D, Olivares JM, Papageorgiou G, Roca M. Improving treatment adherence in your patients with schizophrenia: the STAY initiative. 2013. Clin Drug Investig. 33(2): 97–107. [2] Andreasen NC, Liu D, Ziebell S, Vora A, Ho BC. Relapse duration, treatment intensity, and brain tissue loss in schizophrenia: a prospective longitudinal MRI study. 2013. Am J Psychiatry. 170(6): 609−15. [3] Kishimoto T, Nitta M, Borenstein M, Kane JM, Correll CU. Longacting injectable versus oral antipsychotics in schizophrenia: a systematic review and meta-analysis of mirror-image studies. 2013. J Clin Psychiatry. 74(10): 957−65. Disclosure statement: AS is a full-time employee of Janssen-Cilag Medical & Scientific Affairs Europe, Middle East & Africa and is a shareholder of Johnson & Johnson.