MHM Magazine

Issue 4 | 2021 | MENTALHEALTHMATTERS | 11 MHM other chronic illnesses, the patient would be advised not to fall off the bandwagon, but to continue taking their medication if they want to see continued results, but due to the lack of insight so characteristic of the condition, most schizophrenia patients stop taking their medication within two years of their first episode. Before long, the patient will relapse and find themselves suffering a second, more severe psychotic episode and end up back in a psychiatric hospital. Generally, this whole process happens again and again, leading to a pattern of relapse and remitting for several years before the patient comes to terms with the fact that they do indeed have a chronic condition and decides to stay on their medication. Because schizophrenia has been shown to become worse after each subsequent relapse, some have deemed the first five years of the condition the critical period, wherein, if a health care provider wants to ensure a good long-term prognosis, highly- focused intervention should be provided within this timeframe. Research shows that a small percentage of people, about 8 to 16%, will have only one psychotic episode, receive treatment and never relapse, while, on the other end of the spectrum, 10% of those with severe psychotic symptoms will not respond to any interventions at all – these are the types of patients who become hospitalised or end up in long-term care homes. This leaves around 74% to 80% of people who follow the pattern of relapse and recovery for several years before eventually stabilising. So what then, in terms of treatment and management of the condition? Professor Chiliza suggests that it’s common practice for healthcare providers to assess, prescribe and then book a follow-up for three months. Meaning that for extended periods, the patient is left to their own devices. But is there another, more effective, way? STAGING: THE FUTURE OF SCHIZOPHRENIA TREATMENT In 2010, Nature magazine covered schizophrenia in a feature that looked ahead to 2030 and imagined what treatment for the condition may look like. A key insight made by neuroscientist and then Director of the National Institute for Mental Health in the United States, Thomas Insel, was that healthcare providers should start moving towards staging of the condition, much like the staging of tumors in oncology. The idea being that if we can find neurobiological changes in the brain and identify varying degrees of symptoms in patients, then we can try to categorise the condition into stages from 1 to 4 and implement treatments accordingly. Thomas Insel made this suggestion based on the extensive work of psychiatrist Dr Patrick McGorry , who suggests that clinical staging of people with severe mental illnesses, particularly psychosis, should be taking place to better treat these