Breaking Down Barriers to Quality Care for Patients With Schizophrenia

Author(s):

Leah Kuntz

Key Takeaways

Negative symptoms in schizophrenia persist despite antipsychotic treatment, impacting illness course, costs, and quality of remission.
Digital therapeutics offer adjunctive potential, improving access, reducing stigma, and providing cost-effective, scalable treatment options.
Early digital therapeutics like CBT2go and PRIME show promise in addressing cognitive and motivational deficits in schizophrenia.
Comprehensive care, including family interventions, CBT, physical exercise, and supported employment, is essential for schizophrenia management.
Psychotherapy effectively complements medication in schizophrenia, managing residual symptoms and improving patient functioning.

Digital therapeutics may help improve negative symptoms associated with schizophrenia.

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CONFERENCE REPORTER

“What is holding us back from providing patients with schizophrenia high-quality, comprehensive care?” asked Michael Asbach, DMSc, PA-C, with copresenter Erin Crown, PA-C, Psych-CAQ. In their session at Real Psychiatry in Scottsdale, AZ, Asbach and Crown elaborated on the burden of negative symptoms of schizophrenia, which can lead to prolonged course of illness, more costs, increased comorbidities, and reduced quality of remission.

“Approximately 75% of patients with schizophrenia and 78% of caregivers report that residual negative symptoms are an ongoing concern despite treatment with antipsychotics,” said Asbach.^1-3 “How can we address that?”

The answer may lie with digital therapeutics. Prescription digital therapeutics in particular have an emerging role in schizophrenia care, in what Asbach and Crown call “a new frontier in psychiatry.”

These PDTs:

Have adjunctive potential by complementing medication and psychotherapy, addressing cognitive and behavioral deficits
Can improve access and reduce barriers to care via remote delivery
Provide expanded treatment options via scalable, personalized tool
Reduce stigma via offering a discreet alternative
Are a cost-effective solution with no need for expensive, in-person visits
Enhance health equity by reaching underserved populations

“One of the themes of this conference is the need to stay up to date, to continue to evolve. Medicine is always changing with technologies and changing even faster,” said Asbach. “We’re not saying we need to implement this right now, but rather telling you this is what’s coming. It’s really exciting.”

Early digital therapeutics for schizophrenia include:

CBT2go. Over an 18-week period, this therapeutic reduced defeatist attitudes and experiential negative symptoms in patients with moderate to severe persistent symptoms of schizophrenia.
PRIME. This smartphone app improved self-reported motivation and pleasure deficits in a small randomized trial of participants with early psychosis.
Mobile Enhancement of Motivation in Schizophrenia. This text messaging intervention improved effort-based decision making, motivation, and recovery-oriented goal attainment in an 8-week controlled trial.
CT-155. This prescription digital therapeutic for negative symptoms of schizophrenia received breakthrough device designation in early January of 2024. Asbach and Crown highlighted this particular therapeutic, as it has “high potential to address unmet need.”

Asbach and Crown also feel strongly about the need for comprehensive care for patients with schizophrenia. This includes interventions such as:

Family interventions that can help prevent relapse
Cognitive behavioral therapy (CBT) for psychosis, which reduces symptoms and improves functioning
Physical exercise, has proven health and psychosocial benefits
Supported employment, which leads to higher employment rates, job stability, and skill development

Crown drew special attention to CBT for patients with schizophrenia, as less than 30% of patients with schizophrenia in the United States receive psychotherapy.⁴

“There is a terrible, terrible misunderstanding out there that people with schizophrenia cannot effectively participate in psychotherapy, and it’s not true,” said Crown. “It is not true if it is an appropriate type and style of psychotherapy for them and for their illness.”

While psychotherapy is not a replacement for antipsychotic medication, Crown shared, it does provide critical support for managing residual symptoms and improving functioning for patients.

“There are cognitive, emotional, social targets related to that individual’s lived experiences that can help them develop some coping strategies,” said Crown. “It can help them learn to quiet the noise.”

To read more about insights from Real Psychiatry, check out our conference page here.

References

1. Buchanan RW. Persistent negative symptoms in schizophrenia: an overview. Schizophr Bull. 2007;33(4):1013-1022.

2. Fitzgerald HM, Shepherd J, Bailey H, et al. Treatment goals in schizophrenia: a real-world survey of patients, psychiatrists, and caregivers in the United States, with an analysis of current treatment (long-acting injectable vs oral antipsychotics) and goal selection. Neuropsychiatr Dis Treat. 2021;17:3215-3228.

3. Sicras-Mainar A, Maurino J, Ruiz-Beato E, Navarro-Artieda R. Impact of negative symptoms on healthcare resource utilization and associated costs in adult outpatients with schizophrenia: a population-based study. BMC Psychiatry. 2014;14:225.

4. Jauhar S, McKenna PJ, Radua J, et al. Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. Br J Psychiatry. 2014;204(1):20-29.