Optimizing the Management of Schizophrenia: Evidence-Based Methods to Minimize the Burden of Disease in Managed Care

ACCME-accredited by the University of Kentucky College of Medicine

ACPE-accredited and produced by North American Center for Continuing Medical Education-Princeton CME

Target Audience

This activity is designed for managed markets physicians and pharmacists.

Learning Objectives

After completing this activity, participants should be able to:

Describe the burden of schizophrenia on patient quality of life and healthcare resource use
Outline the frequent comorbidities of schizophrenia and the impact of schizophrenia comorbidities on patient outcomes
Develop and assist providers in facilitating initial assessment and follow-up protocols for patients with schizophrenia
Incorporate evidence-based methods to promote patient adherence with antipsychotic therapy into formulary decisions

Statement of Need

Schizophrenia is a chronic condition with symptoms—such as hallucinations, loss of emotion, and suicidal ideation—that often lead to disability, loss of socioeconomic status, and significant healthcare use.^1-4 Approximately 2.4 million people in the United States have been diagnosed with schizophrenia,⁵ and the annual US cost burden of schizophrenia is estimated at $63 billion, $23 billion of which is attributed to direct healthcare costs.¹ Hospitalization due to relapse is a frequent and costly aspect of schizophrenia management.⁶ Furthermore, patients with uncontrolled schizophrenia are more likely to develop comorbid mental conditions, including mood disorders, obsessive compulsive disorder, and substance abuse.^1,7 Optimizing treatment algorithms and formulary approaches for schizophrenia management is critical to maximizing short- and long-term outcomes. However, despite the availability of safe and effective nonpharmacologic and pharmacologic treatment options,^2,3,8 medication noncompliance is a frequent contributor to poor patient outcomes.⁹ Patient-specific characteristics have been shown to impact antipsychotic drug tolerability, which is a potential contributor to medication noncompliance and often leads to trial and error to identify the safest, most effective, and tolerable antipsychotic medication regimen for the given patient.⁹ Effective, evidence-based treatment initiation and patient follow-up are vital to reducing schizophrenia-related disability,^6,9 and instituting appropriate health plan policies and procedures for recognizing and stratifying patients with schizophrenia may allow for optimal management of the condition.

References

The state of health care quality 2006. National Committee for Quality Assurance Web site. Available at: http://www.ncqa.org. Accessed November 8, 2007.
Keefe RSE, Bilder RM, Davis SM, et al. Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE trial. Arch Gen Psychiatry. 2007;64:633-647.
Sergi MJ, Green MF, Widmark C, et al. Cognition and neurocognition: effects of risperdone, olanzapine, and haloperidol. Am J Psychiatry. 2007;164:1585-1592.
Buchanan RW, Javitt DC, Marder SR, et al. The cognitive and negative symptoms in schizophrenia trial (CONSIST): the efficacy of glutamatergic agents for negative symptoms and cognitive impairments. Am J Psychiatry. 2007;164:1593-1602.
The numbers count: mental disorders in America. National Institute of Mental Health Web site. Available at: . Accessed November 8, 2007.
McDonald M, Hertz RP, Lustik MB, et al. Healthcare spending among community-dwelling adults with schizophrenia. Am J Manag Care. 2005;11:S242-S247.
Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry. 2005;162:1483-1493.
Dunayevich E, Ascher-Svanum H, Zhao F, et al. Longer time to antipsychotic treatment discontinuation for any cause is associated with better functional outcomes for patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder. J Clin Psychiatry. 2007;68:1163-1171.
Surles RC. Atypical antipsychotics: considerations for Medicaid coverage. Am J Manag Care. 2005;11:S248-S253.

Credit Eligibility

To be eligible for documentation of credit, participants must participate in the full educational activity, complete the 10-question post-test with a score of 70% or better, and complete the evaluation form. Participants who successfully complete the post-test and evaluation form online may immediately print their documentation of credit. Those who mail or fax back their successfully completed post-test and evaluation form will receive documentation of credit by mail within 6 weeks.
Participants who have successfully completed the live version of this activity are not eligible to receive credit for this enduring material.

Release date: October 15, 2008

Expiration date: October 15, 2009

Estimated time to complete: 1 hour

There is no fee associated with this activity.

Lecture Components

The audio/video presentation, post-test, and evaluation form are available as a click-through via the menu at the top of this page.

CME Accreditation

The University of Kentucky College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Kentucky College 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.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

The University of Kentucky is an equal opportunity university.

University of Kentucky College of Medicine test code: XEN09017

CPE Accreditation

Princeton CME is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (ACPE Provider #452) and complies with the Criteria for Quality and Interpretive Guidelines. This activity is approved for 1 contact hour (0.1 CEU) of continuing pharmacy education (UPN 452-999-08-022-H01-P).

Any participant wanting to file a grievance with respect to any aspect of a continuing pharmacy education activity accredited by Princeton CME may contact John Savage, Director, Medical Education, North American Center for Continuing Medical Education (NACCME)-Princeton CME, in writing at 300 Rike Drive, Suite A, Millstone Township, NJ 08535; e-mail: jsavage@naccme.com. The Director of Medical Education will review the grievance and respond within 30 days of receiving the written statement. If the participant is unsatisfied with the response, an appeal to the Vice President, Medical Education, NACCME-Princeton CME, may be made for a second level of review.

Independent Clinical Reviewer: Ira D. Glick, MD, Professor of Psychiatry, Stanford University School of Medicine, Stanford, California

Grant Support

Supported by an educational grant from Eli Lilly and Company

Presenters

John M. Kane, MD
Chairman, Department of Psychiatry
The Zucker Hillside Hospital
Professor of Psychiatry, Neurology, and Neuroscience
The Albert Einstein College of Medicine
Glen Oaks, New York

Deanna L. Kelly, PharmD, BCPP
Associate Professor of Psychiatry
Acting Director, Treatment Research Program
Maryland Psychiatric Research Center
University of Maryland School of Medicine
Baltimore, Maryland

Financial Disclosure and Conflicts of Interest

According to the disclosure policy of the University of Kentucky College of Medicine and NACCME-Princeton CME, faculty, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant financial relationships with relevant commercial companies related to this activity. All relevant conflicts of interest that are identified are reviewed for potential conflicts of interest. If a conflict is identified, it is the responsibility of the University of Kentucky College of Medicine and NACCME-Princeton CME to initiate a mechanism to resolve the conflict(s). The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

The faculty has reported the following:

Dr. Glick: Speakers bureau—Astra-Zeneca, Bristol-Myers Squibb, Janssen Pharmaceutica, Pfizer Inc; Research support—Astra-Zeneca, Bristol-Myers Squibb, National Institute of Mental Health, Shire, Solvay, UBH; Consultant—Bristol-Myers Squibb, Janssen Pharmaceutica, Lundbeck, Vanda; Stockholder—Forest, Johnson & Johnson
Dr. Kane: Consultant/advisory board—Astra-Zeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutica, Johnson & Johnson, Lundbeck, Organon, Otsuka, Pfizer Inc, PgXHealth, Proteus, Vanda, Wyeth; Speakers bureau—Astra-Zeneca, Eli Lilly, Bristol-Myers Squibb, Janssen Pharmaceutica; Shareholder—MedAvante
Dr. Kelly: Consultant—Bristol-Myers Squibb, Solvay

Planning Committee Mandy Daniel, the University of Kentucky College of Medicine, and Mary Johnson, Stacey Ohana, Randy Robbin, and John Savage, NACCME-Princeton CME, have disclosed they have no relevant financial relationships with any commercial interests.

The University of Kentucky College of Medicine and NACCME-Princeton CME require faculty to inform participants whenever off-label/unapproved uses of drugs or devices are discussed in their presentations.

The faculty has disclosed that off-label/unapproved use of amisulpride for the treatment of schizophrenia will be discussed.

Privacy Policy

NACCME-Princeton CME protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. NACCME-Princeton CME and our joint sponsors will not release personally identifiable information to a third party without the individual's consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

NACCME-Princeton CME maintains physical, electronic and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Copyright © 2008 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the North American Center for Continuing Medical Education.