Appropriate evaluation of schizophrenia includes assessment of positive symptoms, negative symptoms, and cognitive deficit severity. Medication therapy management (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 will be occasional days where symptoms of schizophrenia may be bothersome.
Nonadherence is a common medication-related problem in 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 and drug cost.
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
As a brain illness with a lifetime prevalence of approximately 1%, schizophrenia is believed to result from abnormalities in neurodevelopment.1,2 The current diagnostic criteria for schizophrenia are published by the American Psychiatric Association in the DSM–5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition).2 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 practitioners conceptualize this serious illness as one that involves 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, impaired social cognition). These two additional areas of concern are believed to result from deficient dopamine activity in the prefrontal cortex. Schizophrenia is an illness with a complex and varied etiology, and, as such, can present in a heterogenous way.1 Table 34-1 describes categorical symptoms of the illness.
TABLE 34-1Schizophrenia Symptom Clusters ||Download (.pdf) TABLE 34-1 Schizophrenia Symptom Clusters
Unusual thought content (delusions)
Impaired working memory
Impaired executive function
While it tends to be an acute exacerbation of positive symptoms that leads to inpatient hospitalization, it is the negative symptoms and cognitive deficits that are most likely to impair a patient’s self-care efforts, as well as their social integration, once they are on a stable course of effective pharmacotherapy.
Other Terms Associated with Schizophrenia
Psychosis - term typically used in reference to hallucinations, delusions, disorganization