Dr Alexandre González Rodríguez shares his experiences about the management of schizophrenia.
Q. When you first tell a patient they have schizophrenia, do you tell them this is a lifelong condition?
A. We tell them that the disease is chronic and needs long-term medication that can lead to normal functioning in some cases. Approximately 30% of patients achieve total remission, 30% partial remission and the remainder have treatment-resistant symptoms.
Q. Having made a diagnosis of schizophrenia – do you tell patients at that point how long they are likely to need to be on medication?
A. We tell our patients that the need for continued medication will be reassessed after 5 years. Pharmacotherapy is given along with psychotherapy (cognitive behavioural therapy and cognitive remediation).
Q. What factors have a large contribution to the quality of life of a patient with schizophrenia?
A. Persistent, chronic symptoms adversely affect patients’ quality of life. Other factors to consider are compliance with medication, access to social support networks, insomnia (is common and is a big problem for patients), co-morbidity with substance abuse, employment status and marital status.
Q. What methods do you employ to preserve or improve the quality of life of your patients with schizophrenia?
A. Insomnia is treated and psychosocial therapy is given. Patients are monitored and their disease status is reassessed every 3-6 months using self-reporting methods and indirect methods, including urine analysis to ascertain both compliance with study medicines and any continuation of substance abuse.
Q. Do you think of schizophrenia as a neurodevelopmental disorder or as a neurodegenerative disease?
A. Both. There is evidence available to support both premises.
Q. What proportion of patients with schizophrenia have the potential to achieve improvements in relationships?
A. The earlier the patients are treated following onset of symptoms, the greater the improvement in their prognosis. Up to 30% of patients show improvements, and 30% partial improvement, in their social skills and personal relationships.