Contemporary Perspectives in Schizophrenia Care

Schizophrenia Emerging Research Collection

by Topic

Human Impact of Relapse

Subtypes of Schizophrenia Revealed

Researchers at the University of Pennsylvania investigate neuroanatomical subtypes using novel machine learning methods.

Two Distinct Neuroanatomical Subtypes of Schizophrenia Revealed Using Machine Learning

The Study

Using structural MRI and deep machine learning, researchers at the University of Pennsylvania became the first to identify 2 distinct, highly reproducible neuroanatomical subtypes of schizophrenia.

The Analysis

Researchers analyzed brain scans of 307 schizophrenia patients and 364 healthy, age-matched controls and identified that ~60% of patients with schizophrenia showed widespread reductions in grey matter, while the remaining 40% had no loss of brain volume, despite controlling for age and duration of illness.

The Reason It Matters

These subtypes challenge the assertion that brain volume loss is a universal feature of schizophrenia and may help facilitate novel strategies for personalized treatment and diagnostics among patients with schizophrenia. These data reinforce the anatomical complexity and heterogeneity within schizophrenia, as well as the importance of individualized care plans for patients.

CHAND GB, ET AL. BRAIN. 2020;143:1027-1038.
Two people wearing lab coats pointing at brain scans on computer screen

Patient-Centric Care

Evidence-Based Treatment for First-Episode Psychosis

This review outlines the evidence supporting early-intervention programs, with an emphasis on coordinated specialty care programs.

Evidence-Based Treatment for First Episode Psychosis: Components of Coordinated Specialty Care

The Study

Each year in the United States, approximately 100,000 adolescents and young adults experience first-episode psychosis. This review outlines the evidence supporting early-intervention programs, with an emphasis on coordinated specialty care (CSC) programs and their key components.

The Analysis

At its core, CSC is a collaborative, recovery-oriented approach that emphasizes shared decision-making to foster collaborative treatment planning and a positive therapeutic relationship. Key components of CSC programs include case management, educational/vocational rehabilitation, cognitive behavioral therapy, and family education.

The Reason It Matters

An abundance of experimental and meta-analytic data over the past 20+ years indicates that comprehensive early-intervention programs can improve symptoms and restore adaptive functioning in a manner that is superior to treatment as usual. Although CSC programs have many benefits for patients with schizophrenia, the opportunity exists to apply them more frequently and consistently for all patients.

Heinssen RK, et al. NIMH. 2014.
A person wearing a lab coat shows another person a screen on a tablet device.

Patient-Centric Care

Outcomes From the RAISE Early Treatment Program

This report presents 2-year data from a study comparing the impact of comprehensive treatment vs usual community care on quality of life.

Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

The Study

This report presents 2-year outcomes data from 404 first-episode psychosis (FEP) patients; 223 patients were assigned to comprehensive, multidisciplinary, team-based treatment (NAVIGATE), and 181 patients received usual community care. The NAVIGATE treatment model included 4 core interventions: personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported employment/education.

The Analysis

The 223 NAVIGATE participants remained in treatment longer, experienced greater improvement in QoL and PANSS scores, and demonstrated more involvement with work and/or school than the 181 participants in standard community care. Notably, NAVIGATE participants with duration of untreated psychosis (DUP) <74 weeks, the median duration for the study, had greater improvement in QoL and psychopathology vs patients with longer DUP.

The Reason It Matters

This robust analysis from the RAISE program demonstrates that clinics across the country may be able to implement team-based intervention models for FEP in order to yield greater improvement in clinical and functional outcomes. The need to extend these models beyond FEP patients to preserve and consolidate functional improvements over the long term remains an area of ongoing investigation.

KANE JM, ET AL. AM J PSYCHIATRY. 2016;173(4):362-372.
Two healthcare professionals talk to a patient lying in a hospital bed.

Patient-Centric Care

The Value of Schizophrenia Treatment

The European Brain Council recently assessed the value of treatment in schizophrenia and examined the gaps in the patient care pathway.

Value of Schizophrenia Treatment I: The Patient Journey

The Study

Founded in 2002, the European Brain Council recently assessed the value of treatment in schizophrenia. The current study presents a descriptive analysis from the first part of this effort, which focused on identifying the unmet needs and gaps in the patient care pathway. The study identified several critical barriers to optimal treatment and proposed the need for a paradigm shift from symptom management to an emphasis on recovery.

The Analysis

In the current model of care, there is insufficient cooperation among health- and social-care providers, patients, and families, as well as inadequate utilization of psychosocial interventions and low implementation of integrated community care. Early-intervention programs should be aimed at reducing the duration of untreated psychosis and preventing relapse in patients with a first episode of psychosis.

The Reason It Matters

Clinical focus is expanding from symptom control to a more holistic view of patient well-being across many psychosocial parameters. Evolving the paradigm requires challenging current healthcare models and moving toward a more comprehensive care model throughout the patient journey.

Mohr P, et al. Eur Psychiatry. 2018;53:107-115.
Two females talking in an office.

Early, Comprehensive Intervention

Early Intervention Services

This systematic review analyzed clinical outcomes among early-phase psychosis patients who received either early intervention services or treatment as usual.

Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression

The Study

Comprehensive early intervention in psychosis remains an ongoing area of debate regarding both its clinical value and when/how to allocate public resources. This rigorous systematic review of 10 randomized clinical trials comprising 2,176 patients analyzed clinical outcomes among early-phase psychosis patients who received either early intervention services (EIS) or treatment as usual (TAU). EIS consisted of antipsychotic treatment and 4-6 evidence-based psychosocial interventions.

The Analysis

Patients who received EIS for 6 to 24 months demonstrated superior outcomes vs those receiving TAU in all 13 meta-analyzable outcomes, including hospitalization risk, bed-days, symptom severity, global functioning, and all-cause treatment discontinuation. Importantly, duration of untreated psychosis did not appear to be predictive of the superior outcomes observed in the EIS group.

The Reason It Matters

These results further reinforce the need for widespread funding and implementation of EIS among patients with early-phase psychosis. Importantly, several lines of evidence indicate that gains made at Year 2 could be sustained or increased with EIS at a lower level for another 3 years, suggesting that the duration of EIS is an additional key factor to consider along the patient journey.

Correll CU, et al. JAMA Psychiatry. 2018;75(6):555-565.
A close up of multiple brain scan images

Early, Comprehensive Intervention

High COVID-19 Mortality in Patients with Schizophrenia

This 2021 cohort study assessed whether a schizophrenia diagnosis was associated with an increased risk of mortality in patients who tested positive for COVID-19.

Association of Psychiatric Disorders With Mortality Among Patients With COVID-19

The Study

Increased incidence of COVID-19 among individuals with mental health disorders, including schizophrenia, has been reported in multiple nationwide cohort studies in the US. However, prior to this retrospective cohort study, the association between schizophrenia spectrum disorders and mortality rates in COVID-19 had not been evaluated.

The Analysis

Over 7,300 adult patients who tested positive for COVID-19 were assessed for 45 days following a confirmed diagnosis. Results of this study indicate that a diagnosis of schizophrenia spectrum disorder was associated with increased risk for 45-day mortality after controlling for age, race, and known medical risk factors.

The Reason it Matters

Taken together with prior cohort studies, these data suggest that patients with schizophrenia are at increased risk for COVID-19 infection and for more severe or fatal manifestations of the disease. In fact, schizophrenia is now recognized as the second-greatest risk factor, after age, for early death from COVID-19. In such a vulnerable population, already susceptible to increased infection, determining which patients may be at the highest risk for severe disease is necessary to guide clinical decision-making.

NEMANI K, ET AL. JAMA PSYCHIATRY. 2021;78(4):380-386.
A close up of corona virus.

Early, Comprehensive Intervention

Effects of Prolonged Duration of Untreated Psychosis

This study compared the relationship between duration of untreated psychosis with symptoms and social outcomes.

Effect of Delaying Treatment of First-Episode Psychosis on Symptoms and Social Outcomes: A Longitudinal Analysis and Modelling Study

The Study

Previous lines of research suggest that prolonged periods of untreated psychosis may be associated with higher risk of worsening symptoms and functional decline in schizophrenia. This study aimed to assess the relationship between duration of untreated psychosis (DUP) and symptom severity at 6 months, as well as the relationship between DUP and treatment response.

The Analysis

This study included data from 2 longitudinal cohorts of more than 1,200 patients with first-episode psychosis presenting to early intervention services. Longer DUP predicted reduced treatment response. Additionally, the modeled effect of prolonging DUP by 10-fold was comparable to the difference between treating patients with antipsychotics vs placebo. Harm incurred by treatment delay appeared to be greatest in the early weeks of psychosis.

The Reason It Matters

Evidence from this study highlight the need for early pharmacologic and psychosocial intervention among patients experiencing psychosis. Harmful effects of delays in treatment appear to be greatest in the first weeks after symptom onset and then proceed more slowly in the months afterwards.

DRAKE RJ, ET AL. LANCET. 2020;7(7):602-610.
A close up of a patient’s hands while speaking to psychiatrist.

Early, Comprehensive Intervention

The RAISE Initiative

This review investigates emerging practices that support the value of early intervention and reduced duration of untreated psychosis, specifically comprehensive care models used in the RAISE Initiative.

Transforming the Treatment of Schizophrenia in the United States: The RAISE Initiative

The Study

In 2009, the National Institute of Mental Health funded a set of research studies, called the Recovery After an Initial Schizophrenia Episode (RAISE) initiative, with a mission to reduce the duration of untreated psychosis and improve the course of illness. These studies contributed to the creation of a new comprehensive way to approach schizophrenia management, called coordinated specialty care (CSC).

The Analysis

This review dives deeper into the events that triggered initiation of the RAISE initiative, key findings from the studies, as well as the challenges and knowledge gaps that remain. The positive results from the RAISE studies have facilitated a national shift toward early, comprehensive treatment intervention services for more individuals living with schizophrenia.

The Reason it Matters

CSC programs have established their value in improving early outcomes, and they should be available as standard care for new-onset psychosis. Many questions still remain regarding how to reduce DUP, optimize accessibility to CSC programs for more patients, and sustain the benefits of CSC after patients complete the program.

A patient and a doctor in an exam room

Early, comprehensive intervention

A Blueprint for Protecting Physical Health

This article summarizes the physical health disparities among people with mental illness and presents clear direction for promoting improved overall health and clinical care.

The Lancet Psychiatry Commission: A Blueprint for Protecting Physical Health in People With Mental Illness

The Study

Individuals with mental illness are more likely to have poor physical health compared to the general population and are at an increased risk for early mortality due to common comorbidities such as obesity, diabetes, and cardiovascular diseases, as well as reduced access to quality care. This report summarizes the advances for understanding these topics and present clear recommendations for adequate care.

The Analysis

The aims of the Commission were to discuss the physical health disparities among people with mental illness, modifiable factors in health-related behaviors, the relationship between antipsychotics and physical health, better integration of physical and mental health care, and a multidisciplinary approach to treating patients.

The Reason it Matters

This robust analysis from the Lancet Psychiatry Commission demonstrates that more can be done to improve the physical and mental health for people with mental illness. The disparities in physical health for these patients can be reduced through evidence-based prescribing and a better integration of physical and mental health care.

FIRTH J, ET AL. LANCET PSYCHIAT. 2019;6(8):675-712.
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Explore More

Cross sections of the brain highlight showing the different regions associated with social cognition
Early, Comprehensive intervention 4 min

A Growing Emphasis
on Social Cognition

Dr. Michael Green explores the connection between social cognition and functional outcomes.

Single orange sphere rotates in vast open space with small white spheres surrounding visualizing the human impact of relapsing in schizophrenia

Quantifying the
Human Impact of
Schizophrenia Relapse

This interactive tool explores the widespread effects of relapse and ways to remediate them.

Light reflecting on a silver spoon symbolizing the relation of the amount of brain volume loss with schizophrenia relapse
Early, Comprehensive intervention 5 min

What Does a Spoon
Have to Do With

Renowned psychiatrist Dr. René Kahn explains the neuroanatomical consequences of first-episode psychosis.

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