arrow Log In to View Account     |      
HOME
Johns Hopkins Medicine
Hopkins Logo


Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Modern Approach to the Pharmacologic and Psychosocial Treatment of Schizophrenia and Psychosis


GOAL
To provide psychiatrists with information on the most recent developments regarding the pharmacologic and psychosocial treatment of schizophrenia and psychosis.

TARGET AUDIENCE
This activity is designed for psychiatrists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Determine therapeutic goals and benefits of the use of concomitant cognitive behavior therapy and antipsychotic medication in patients with schizophrenia.
  • Identify the benefits of focusing on recovery rather than merely relapse prevention in patients with schizophrenia.
  • Discuss the barriers that exist in the pharmacologic and psychosocial management of psychotic disorders.
  • Define the diagnostic boundaries between bipolar disorder and schizophrenia and how diagnosis affects treatment selection.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 2 hours.

Release date: September 15, 2003. Expiration date: September 15, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Bristol-Myers Squibb Company and Otsuka America Pharmaceutical, Inc.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As sponsors accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Council on Pharmaceutical Education (ACPE), it is the policy of Johns Hopkins University School of Medicine and the University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    Nicola Cascella, MD
    Assistant Professor
    Department of Psychiatry
    Johns Hopkins University
    School of Medicine
    Baltimore, Maryland
    • Dr Cascella reports serving as a consultant to Bristol-Myers Squibb Company, Eli Lilly and Company, Gerson Lehrman Group, IVAX Corporation, and Janssen Pharmaceutica.

PARTICIPATING FACULTY

    John M. Kane, MD
    Chairman, Department of Psychiatry
    Long Island Jewish Medical Center
    Dr E. Richard Feinberg Chair in Schizophrenia Research
    Professor of Psychiatry and Neurology
    Albert Einstein College of Medicine
    Zucker Hillside Hospital
    Glen Oaks, New York
    • Dr Kane reports serving as a consultant to Abbott Laboratories, AstraZeneca LP, Aventis Pharmaceuticals Inc, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceutica, Novartis Corporation, Organon, and Pfizer, Inc.

    Bryan L. Roth, MD, PhD
    Professor
    Department of Biochemistry
    Case Western Reserve University School of Medicine
    Cleveland, Ohio
    • Dr Roth reports serving as a consultant to Arena Pharmaceuticals, Inc, Bristol-Myers Squibb Company, Eli Lilly and Company, Forest Pharmaceuticals, Inc, and SK Corporation; and receiving honoraria from Bristol-Myers Squibb Company and Eli Lilly and Company.

    Stephen M. Strakowski, MD
    Professor of Psychiatry, Psychology, Neuroscience, and Biomedical Engineering
    Director, Center for Imaging Research
    Director, Bipolar and Psychotic Disorders Research Program
    University of Cincinnati College of Medicine
    Director of Clinical Research and the General Clinical Research Center
    Veterans Affairs Medical Center
    Cincinnati, Ohio
    • Dr Strakowski reports receiving grant and/or research support from AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceutica, and Otsuka Pharmaceuticals; serving as a consultant to AstraZeneca LP, Bristol-Myers Squibb Company, Ortho-McNeil Pharmaceutical, Inc, and Otsuka Pharmaceuticals; and holding stock in Pfizer, Inc. He has received honoraria from all of the above companies.

    Douglas Turkington, MD, FRCPsych
    Senior Lecturer
    Department of Neurology, Neurobiology, and Psychiatry
    University of Newcastle upon Tyne
    Department of Psychiatry
    Royal Victoria Infirmary
    Newcastle, United Kingdom
    • Dr Turkington reports receiving grant and/or research support from and serving as a consultant to Pfizer, Inc; and receiving honoraria from Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceutica, and Pfizer, Inc.

    Peter J. Weiden, MD
    Professor of Psychiatry
    Director, Schizophrenia Research Program
    Department of Psychiatry
    State University of New York Health Science Center
    Brooklyn, New York
    • Dr Weiden reports receiving grant and/or research support from Abbott Laboratories, AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceutica, and Pfizer, Inc; serving as a consultant to AstraZeneca LP, Eli Lilly and Company, Janssen Pharmaceutica, Merck & Co, Inc, Novartis Corporation, and Pfizer, Inc; and serving on the speakers' bureau for AstraZeneca LP, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceutica, and Pfizer, Inc.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty member has disclosed that his article has referenced the following unlabeled/unapproved uses of drugs or products:

Dr Strakowski - antipsychotics for the treatment of bipolar disorder.

All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Modern Approach to the Pharmacologic and Psychosocial Treatment of Schizophrenia and Psychosis
Nicola Cascella, MD*

There have been significant advances in the pharmacologic and psychosocial treatments of schizophrenia and other psychotic disorders. These advances have challenged common treatment assumptions—that patients with schizophrenia cannot recover, that good vs poor outcome is the best criterion for distinguishing schizophrenia from bipolar disorder, and that psychotic symptoms are not amenable to psychotherapeutic interventions. The dopamine hypothesis of schizophrenia continues to evolve. Pharmacologic therapies will, more and more, strive to normalize dopamine dysfunction instead of globally decreasing its function. One fundamental goal of medication selection is to achieve remission with a minimum of burdensome side effects instead of merely symptom control.

Likewise, psychologic intervention with modified cognitive behavioral therapy is endeavoring to help patients reestablish more appropriate responses. The long-term prognosis of schizophrenia is consistently moving from deterioration to stabilization and even recovery. Meanwhile, the more favorable safety profiles of newer pharmacologic therapies have helped clinicians to approach patients in a more practical, flexible, and individualized way.

This issue of Advanced Studies in Medicine addresses some important changes in the understanding and treatment of schizophrenia and other psychotic disorders. Based on proceedings from the American Psychiatric Association's 2003 annual meeting, held in May 2003, the articles represent the insights and perspectives of internationally known thought leaders in this field.

Douglas Turkington, MD, FRCPsych, describes psychological models that trigger and maintain psychotic symptoms and that form the basis for psychotherapeutic intervention, as well as results of recent clinical trials testing cognitive-behavioral therapy.

Bryan L. Roth, MD, PhD, reviews the mechanisms of action of the second-generation antipsychotics and offers a tool the National Institute of Mental Health has developed to allow clinicians to better predict the side-effect profile of various agents.

Peter J. Weiden, MD, reviews some of the inadequacies of methods used in clinical investigations of psychotic patients and stresses the value of including clinical observations in treatment decisions. He also reviews some of the clinical profiles of antipsychotic agents and how clinicians may best approach the decision about whether a medication switch would be helpful to patients and their families.

John M. Kane, MD, focuses on the challenge of preventing relapse in patients being treated for schizophrenia, as well as the importance of focusing on recovery rather than merely relapse prevention in these patients. He also discusses treatment options for patients who fail initial therapy, a significant challenge well known to all clinicians.

Stephen M. Strakowski, MD, reviews the often-difficult topic of differentiating between bipolar disorder and schizophrenia. Dr Strakowski also reviews the properties of some of the newer agents available to treat these conditions and their tolerability profiles, as well as results from recent clinical trials of combination therapy. Response to treatment seems to further blur the line that separates schizophrenia from bipolar disorders, a result that is in line with recent genetic studies showing an overlap between these diagnostic categories.

The following pages offer clinicians an excellent understanding of some of the issues surrounding the diagnosis and treatment of psychoses. New cognitive and pharmacologic therapies are offering hope for better prevention of relapse and for improved psychosocial functioning.

*Assistant Professor, Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.