Bridging the Gap to Improved Schizophrenia Treatment Options

Schizophrenia is a debilitating mental illness that affects roughly 2.8 million people in the United States alone. It is a type of psychosis characterized by delusions and hallucinations, which often includes hearing voices that aren’t actually there. Schizophrenia not only impacts one’s mood, but also their behavior and social competency.

Similar to other psychotic disorders, schizophrenia tends to manifest during early adulthood, commonly between the ages of 18 and 25. Often, those with schizophrenia spectrum disorders develop comorbid conditions, including depression and substance abuse. Alcohol, cannabis, nicotine, and cocaine use have all been heavily linked to schizophrenia spectrum disorders.

Given this strong correlation, improved treatment options are imperative to diminishing the link between schizophrenia and the onset of comorbid conditions, including substance abuse.

The Relationship Between Schizophrenia and Substance Abuse

A 2024 study published in Psychiatric Services illustrated the challenges those with schizophrenia face in their pursuit of quality treatment.

The two-year analysis focused on 114 patients between the ages of 18 and 65 who had schizophrenia spectrum disorders. Of those patients, many presented comorbid mental health conditions, including depression and post-traumatic stress disorder. Many patients also struggled with alcohol (23%) and cannabis (20%) use.

According to the study, only 71% of adults with schizophrenia spectrum disorders had participated in some degree of mental health treatment over the last year. However, of those individuals, only 26% reported receiving treatment that adequately managed their condition.

Improving Treatment Options for Schizophrenia

The prevalence of substance abuse issues in schizophrenia patients may be mitigated with an optimized treatment roadmap. Medication can be helpful in managing schizophrenia symptoms, but combining treatment options is often most effective in managing the disorder.

Counseling is key for patients with schizophrenia spectrum disorders. This can come in various forms, including:

Cognitive Behavioral Therapy (CBT): CBT has proven to help reduce symptoms of schizophrenia, including hallucinations and paranoia, by focusing on coping mechanisms and improving problem-solving skills.

Group Therapy: Group therapy not only helps with skills implemented in CBT, but also improves social competency by encouraging group interactions and fostering a sense of community in an emotionally supportive environment.

Family Therapy: Much like group therapy, family therapy centers around educating patients and their families as a collective unit. This promotes social interaction, helps the family explore support methods for the diagnosed patient, and provides tools for crisis planning.

These therapies can be highly effective in managing schizophrenia symptoms. Still, patients should also be prescribed one of several medications administered for psychotic disorders. These include:

• Aripiprazole
• Clozapine
• Olanzapine
• Risperidone

In 2024, the FDA also approved a new drug—KarXT, which is a combination of xanomeline and trospium—aimed at reducing schizophrenia symptoms and improving overall cognitive function by targeting muscarinic receptors in the brain rather than dopamine receptors. KarXT has resulted in improved symptom management for those battling schizophrenia, and it even has the potential to become treatment option for Alzheimer’s.

References:

Natalie Bareis, L. M. S. W., Mark Edlund, M. D., Heather Ringeisen, Ph. D., Heidi Guyer, Ph. D., Lisa B. Dixon, M. D., Mark Olfson, M. D., Thomas E. Smith, M. D., Lydia Chwastiak, M. D., Maria Monroe-DeVita, Ph. D., Marvin Swartz, M. D., Jeffrey Swanson, Ph. D., Elizabeth Sinclair Hancq, M. P. H., Paul Geiger, Ph. D., Noah T. Kreski, M. P. H., T. Scott Stroup, M. D., Natalie Bareis, L. M. S. W., Mark Edlund, M. D., Heather Ringeisen, Ph. D. D. of P., Heidi Guyer, Ph. D. D. of P., … T. Scott Stroup, M. D. (n.d.). Characterizing schizophrenia spectrum disorders: Results of the U.S. mental and substance use disorders prevalence study. Psychiatric Services. https://www.psychiatryonline.org/doi/10.1176/appi.ps.20240138

Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse in patients with schizophrenia. Dialogues in Clinical Neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181760/#:~:text=Neurobiological%20aspects,-In%20general%2C%20common&text=Schizophrenia%20has%20been%20suggested%20to,an%20increased%20vulnerability%20to%20addiction.

Schizophrenia fact sheet - treatment advocacy center. Treatment Advocacy Center -. (2024, January 3). https://www.tac.org/reports_publications/schizophrenia-fact-sheet/#:~:text=Schizophrenia%20is%20a%20chronic%20and,untreated%20in%20any%20given%20year.

Chapple, R., & Ertel, A. (2024, May 3). Therapy for schizophrenia: 8 effective types - talkspace. Mental Health Conditions. https://www.talkspace.com/mental-health/conditions/schizophrenia/therapy-treatment-types/#:~:text=%E2%80%9CThe%20best%20treatments%20for%20schizophrenia,therapy%2C%20and%20group%20counseling.%E2%80%9D

Lupkin, S. (2024, September 27). A new kind of drug for schizophrenia promises fewer side effects. NPR. https://www.npr.org/sections/shots-health-news/2024/09/27/g-s1-25089/karxt-cobenfy-schizophrenia-psychosis-fda

Sauder, C., Allen, L. A., Baker, E., Miller, A. C., Paul, S. M., & Brannan, S. K. (2022, November 21). Effectiveness of KarXT (xanomeline-trospium) for cognitive impairment in schizophrenia: Post hoc analyses from a randomised, double-blind, placebo-controlled phase 2 study. Translational psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9681874/