MHM Magazine

Issue 4 | 2021 | MENTALHEALTHMATTERS | 13 MHM than later stage treatment. Often, the same dose of medication provided during the first episode will be ineffective during later stages. This also means that at times, first-line anti-psychotics become ineffective and medications with less desirable safety profiles become the only option for treatment. A study at UCLA compared patients with first-episode schizophrenia who received oral risperidone with patients receiving a long-acting injectable of the same drug and found that relapse rates in those who received injectables were significantly lower (5%) than for those receiving oral medications (33%). Another benefit of injectables is that they need to be administered by a nurse and so there is better chance of patients sticking with treatment. This suggests that there is something to be said about using long-acting injectables as first-line treatment during the early stages of schizophrenia. RECOVERY Traditionally, the idea of recovery in schizophrenia seemed largely unachievable, as recovery meant the presence of no symptoms, but modern notions of the illness suggest that even with the presence of some symptoms, if the patient can take care of themselves, has hope and things to do, they’re in recovery. Helping patients to rediscover a sense of agency and meaning in their lives after experiencing a psychotic episode is a vital part in aiding their recovery. Dr John Parker a psychiatrist at Lentegeur Mental Hospital in the Cape flats started the Lentegeur Spring Project, which aims to integrate patients back into their communities through green initiatives such as food- gardening and greening the hospital environment. He believes this provides a sense of self- sufficiency and meaning to the patients who partake in the project, and has found that many have experienced significant improvement. Other studies have indicated that schizophrenia patients report that having a sense of purpose and personal spirituality are important in moving toward recovery, and that the challenges posed by societal stigma are among the greatest obstacles to recovery. MORTALITY The topic of schizophrenia can’t be fully explored without discussing mortality. Recent studies have found that people with schizophrenia have a reduced life expectancy. On average, people with schizophrenia live 20 years less than other people. Initial response to these by healthcare providers was to question whether the use of anti- psychotics and their resulting side effects in people with schizophrenia were to blame for the higher than usual death rates, but further studies have shown that it’s young people with schizophrenia that are at greatest risk for dying -- mostly due to being untreated and suicide. Research done in Scandinavia has also shown that those on medication have a better life expectancy, and that any anti- psychotic is better than no treatment at all. What is important to consider and implement when treating people with schizophrenia however, is to manage negative side-effects such as significantly increased weight gain, which can lead to a host of health conditions such as diabetes, hypertension, and metabolic syndrome. Why some people tend to put on more weight than others is still unclear. Evidence shows that if a patient starts anti-psychotics and gains more than 5% of their weight within the first month of treatment, then they are at most risk of gaining a significant amount of weight by the one-year mark of treatment, and these patients should be monitored closely. Often these patients’ weight does not plateau and intervention is required to put a stop to it. This means that healthcare providers need to inform their patients of the risks and provide them with psychoeducation around how to lead a balanced and healthy lifestyle. Smoking cessation is an especially important intervention. Recent studies done in KwaZulu-Natal suggest that screening for metabolic syndrome among schizophrenia patients is less common than it should be and so it is recommended health care providers do this more frequently. COVID-19 While there are no experts on COVID-19 and schizophrenia yet, it’s important to bear in mind that in all likelihood, people with schizophrenia are at a significantly increased risk during the COVID-19 pandemic. Recent literature out of the United States and China suggests that people with schizophrenia have difficulty with adhering to public health mandates and principles and because many have comorbidities, they’re at increased risk. On top of the immediate health risks, there is an anticipation of adverse mental health consequences to people with schizophrenia, as they’re likely to suffer from isolation and other measures necessary during the pandemic. References available upon request