Neuroprotection: A New Strategy in the Treatment of Schizophrenia (63:51 Minutes)

Section Editor: David L. Ginsberg, MD

Authors:

Jeffrey A. Lieberman, MD
Peter F. Buckley, MD
Diana O. Perkins, MD, MPH

This is a 1-hour PsychCast podcast with an Internet component.

Release Date: November 15, 2007
Termination Date: November 15, 2009

Funding for this activity has been provided through an educational grant from Eli Lilly and Company.

Faculty Affiliations and Disclosures:

Dr. Lieberman is chairman of the Department of Psychiatry at Columbia University College of Physicians and Surgeons, director of the New York State Psychiatric Institute and the Lieber Center for Schizophrenia Research, and psychiatrist-in-chief of the New York-Presbyterian Hospital and Columbia University Medical Center in New York City.

Disclosures: Dr. Lieberman is a consultant to Eli Lilly and Pfizer; is on the advisory boards of AstraZeneca, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, and Pfizer; receives grant/research support from Acadia, Bristol-Myers Squibb, GlaxoSmithKline, Janssen, Merck, Organon, and Pfizer; and is a patent holder for Repligen. He receives no financial compensation or salary support for participation as a consultant or member of an advisory board.

Dr. Buckley is professor and chairman in the Department of Psychiatry and Health Behavior at the Medical College of Georgia, in Augusta.

Disclosures: Dr. Buckley is a consultant to Abbott, Alamo, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, Merck, Roche, Solvay, and Wyeth; receives grant/research support from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, National Institute of Mental Health, Pfizer, Solvay, and Wyeth; and receives honorarium/expenses from Abbott, Alamo, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, and Pfizer.

Dr. Perkins is professor of psychiatry, medical director of Outreach and Support Intervention Services, and director of the Schizophrenia Treatment and Evaluation Program at the University of North Carolina at Chapel Hill.

Disclosures: Dr. Perkins receives research support from Janssen; consulting fees from Bristol-Myers Squibb; and compensation for services on the advisory boards as well as honoraria from AstraZeneca, Bristol-Myers Squibb, and Eli Lilly.

Statement of Need and Purpose: Schizophrenia is a chronic mental disorder characterized by psychosis, delusional behavior, and hallucinations. Research has demonstrated that the prognosis for schizophrenia is affected by the amount of time between the initial onset of psychotic symptoms and adequate pharmacologic treatment. Research has unveiled biological markers that correlate with schizophrenia symptoms and support the importance of early intervention for patients with schizophrenia. Neuroimaging studies have demonstrated that there is a neurodegenerative syndrome associated with the cognitive decline that accompanies first-episode psychosis and that loss of gray matter is most significant during early psychosis. In order to achieve a full neuroprotective effect, symptoms must be treated early and to full remission. Both conventional and atypical antipsychotics are effective for treating the symptoms of schizophrenia later in the course of illness, although atypicals appear to have a more significant neuroprotective effect at the time of initial psychosis. Patients who discontinue pharmacologic treatment run a higher risk of relapse with each episode. Managing medication side effects, as well as use of psychosocial interventions can improve treatment adherence. Given the overall burden of schizophrenia new efforts at early detection and early treatment with effective antipsychotics are essential. Clinicians must be vigilant in looking for symptoms of schizophrenia and aggressive in treating the disorder once the patient has been diagnosed.

Learning Objectives

• Recognize the latest evidence of neurodegeneration associated with cognitive decline in schizophrenia.
• Explain the benefits and risks of pharmacologic treatments.
• Describe the impact of relapse and the need for compliance in limiting the burden of illness in patients with schizophrenia.

Target Audience: This activity is designed to meet the educational needs of psychiatrists.

Peer Reviewers:

David L. Ginsberg, MD, receives honoraria and research support from AstraZeneca, Cyberonics, and GlaxoSmithKline.

Eric Hollander, MD, reports no financial, academic, or other support that may pose a conflict of interest. This activity has been peer reviewed and approved by Eric Hollander, MD, Chair and Professor of Psychiatry at the Mount Sinai School of Medicine. Review date: September 11, 2007.

Accreditation Statement: This activity has been planned and implemented in accordance with the Essentials and Standards of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Mount Sinai School of Medicine and MBL Communications, Inc. The Mount Sinai School of Medicine is accredited by the ACCME to provide Continuing Medical Education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosure Policy Statement: It is the policy of the Mount Sinai School of Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. This information will be available as part of the course material.

Disclaimer: These are the opinions of the authors not of the sponsors or supporters. For more information, contact MBL Communications at cme@mblcommunications.com.

Minimum Hardware/Software Requirements

Macintosh: PowerPC processor, Mac OS 8.6, 9.0.4, 9.1, or Mac OS X, 64MB of RAM, 24MB of available hard-disk space, and Safari 1.x or 2.x.
Windows PC: Intel Pentium processor, Microsoft Windows 95 OSR 2.0, Windows 98 and 98 SE, Windows Millennium Edition, Windows NT 4.0 with Service Pack 5, Windows 2000, or Windows XP, 64MB of RAM, 24MB of available hard-disk space, and Internet Explorer 6.x and newer or Firefox 1.x and newer.

This CME Activity and Posttest information file is a PDF (Portable Document Format) document. To view this file, you will need Adobe Acrobat Reader, which is available free at www.adobe.com. Follow the instructions on that page to download and install the software.

Neuroprotection: A New Strategy in the Treatment of Schizophrenia (63:51 Minutes) Section Editor: David L. Ginsberg, MD Authors: Jeffrey A. Lieberman, MD Peter F. Buckley, MD Diana O. Perkins, MD, MPH Abstract Intervention in the progression of schizophrenia is an effort not just to deter psychosis but also to protect the brain from physiologic deterioration. Neurodegeneration is believed to result from neurochemical dysregulation during the onset of schizophrenia. Deterioration accrued over recurring psychotic episodes causes cumulative loss of cell processes, loss of gray matter volume, and apoptosis. Neurodegeneration ultimately results in persistent symptomology and functional impairment. Functional decline occurs early in the course of schizophrenia, and the symptoms that emerge during the prodromal stage may derail the normal adolescent neurodevelopment. Both first-episode psychosis and the prodrome may be opportunities to forestall neurodegeneration. Unfortunately, people with schizophrenia often experience a long duration of untreated psychosis. Treatment of first-episode psychosis with antipsychotic agents shows robust response. However, early-stage patients have very high rates of medication noncompliance. Treatment in the prodrome may offer the best chance to delay the onset of illness, perhaps mitigate its severity after onset, or even prevent onset entirely. Nonpharmacologic treatments during the prodrome, such as education, treatment for substance use, and cognitive-behavioral therapy, are low-risk interventions that are potentially beneficial. Pharmacologic interventions during the prodrome are also effective in delaying onset of illness, but carry the risk of adversely affecting patients who are false positives for prodromal schizophrenia. In this Expert Roundtable PsychCast™, Jeffrey A. Lieberman, MD, provides an overview of the neurobiological basis of neurodegeneration and the concept of neuroprotection. Next, Peter Buckley, MD, reviews the importance of first-episode psychosis, including duration of untreated illness and medication adherence. Finally, Diana O. Perkins, MD, reviews treatment strategies of prodromal schizophrenia. To receive credit for this activity: Listen to the PsychCast™, reflect on the material presented, and complete the online CME Posttest/Evaluation here or to submit the CME Posttest/Evaluation by mail or fax, download a PDF here. To obtain credit, you should score 70% or better. The estimated time to complete the PsychCast™ and the posttest and evaluation is 1 hour. Successful completion of the posttest and evaluation will allow you to claim credit and print a certificate. Early submission of this posttest is encouraged: please submit by November 15, 2009 to be eligible for credit. If you have any questions, please e-mail cme@mblcommunications.com. Read the extended CME supplement related to this PsychCast™ activity here Supported by Eli Lilly and Company
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