John M. Kane, MD: The treatment of schizophrenia is a complex challenge, and I think there are many unmet needs. We have a number of patients who don’t respond adequately to the treatments that we use. In addition, we have a large proportion of patients who have difficulty adhering to the medication that we prescribe. There are a lot of relapses and hospitalizations that occur, which we could avoid. In addition, there are many patients who still have difficulty functioning, in terms of psychosocial and vocational abilities, so we need to do more, in terms of helping people get back to work or back to school or back to being a homemaker—whatever it is that they choose to do. Many of our patients still need a lot of help in achieving those goals.
The challenges in treating schizophrenia are really multifold. When the illness begins, it’s usually in late adolescence or in early adulthood. At that point, the individual who is affected can have difficulty recognizing that something is wrong and accepting the need for treatment. One of our challenges is a very long duration of untreated illness or untreated psychosis. We need to do a much better job of engaging people earlier with treatment, helping them to identify that something’s wrong, helping their families to identify that there’s a problem, and knowing what to do about it. It can be quite confusing.
In the early stages of illness, people often don’t have insight, so they may experience psychotic signs and symptoms, such as delusions or hallucinations, but not really recognize that these are irrational or illogical. Therefore, they don’t always see the need for immediate help. That’s a big challenge for us. And once we do get someone to accept the need for treatment and engage in treatment, it can be difficult to sustain that engagement, because if they’re feeling better, they may drop out of treatment and think that it’s no longer necessary. Those are some of our biggest challenges. In some cases, the better that someone is doing, the less likely they are to see the need for continued treatment, so they stop the treatment and end up getting sick again. Sometimes, we get into this vicious cycle of improvement, relapse, and deterioration, and then we try to bring in that improvement. It’s not always easy to get back to where you were before.