Appropriate evaluation of schizophrenia includes assessment of patients' positive symptoms, negative symptoms, and severity of cognitive deficits. MTM providers working with patients with schizophrenia should be adequately trained in the use of common rating scales.
MTM providers should educate patients to be realistic about the expected outcomes of antipsychotic therapy, ie, even when medication is taken as prescribed, there may be days when symptoms of schizophrenia may be bothersome.
Nonadherence is a common medication-related problem among patients with schizophrenia. MTM providers should be vigilant for nonadherence and work with the patient and provider to find a regimen that promotes adherence and minimizes adverse effects along with drug costs.
Metabolic syndrome and extrapyramidal symptoms are concerning adverse effects of antipsychotic drug therapy. MTM providers should monitor for these adverse effects and recommend appropriate changes in therapy to help minimize their consequences.
INTRODUCTION TO SCHIZOPHRENIA
A brain illness with a lifetime prevalence of approximately 1%, schizophrenia is believed to result from neurodevelopmental abnormalities. The current diagnostic criteria for schizophrenia are published by the American Psychiatric Association.1 Presently, the diagnostic criteria for schizophrenia focus on the long-term presence of specific symptoms (eg, auditory hallucinations, paranoia, disorganized speech) that ultimately result in profound functional impairment. While many pharmacists conceptualize this serious illness as stemming from excessive dopamine activity in the limbic system of the brain, schizophrenia is much more than that. Beyond the characteristic "positive" symptoms of schizophrenia, patients with this illness typically also have "negative" symptoms (eg, amotivation, alogia) and cognitive deficits (eg, poor concentration, poor memory, slowed processing speed). These additional symptom domains are believed to result from deficient dopamine activity in the prefrontal cortex. Schizophrenia is an illness with a complex as well as varied etiology and, as such, can present in diverse ways. Table 34-1 describes categorical symptoms of the illness.
Table 34-1.Schizophrenia Symptom Clusters1, 2, 3 ||Download (.pdf) Table 34-1. Schizophrenia Symptom Clusters1, 2, 3
|Positive ||Negative ||Cognitive |
Unusual thought content (delusions)
Impaired working memory
Impaired executive function