APA: Psychiatrists Want More Effective Antipsychotics

SAN DIEGO, May 24 -- Pharmacotherapy for schizophrenia may be better than it's ever been, but it's not nearly good enough.

In a nationwide survey of psychiatrists, 95% said that there is a need for new, highly effective drug options, said Peter Buckley, M.D., of the Medical College of Georgia.

About the same percentage of respondents said that their patients would directly benefit from such therapies, said Dr. Buckley at an industry-funded symposium presented in conjunction with the American Psychiatric Association meeting here.

The survey, conducted by Harris Interactive and commissioned by Janssen, polled psychiatrists who work in a wide variety of clinical settings-hospitals, community health centers, private practice, correctional facilities, nursing homes, and others.

The psychiatrists were recruited from the AMA's master file, and participated in an online interview conducted in August and September of 2006. In all, 405 psychiatrists participated (about a 50% response rate).

The participants were asked about their perceptions of current medications, their prescribing and treatment practices, reasons for discontent with existing therapies, patient access to multiple medications, frequency of medication changes, and the drivers of the change.

The survey also asked whether psychiatrists felt that they had to make a tradeoff between the efficacy of antipsychotic agents and the safety and tolerability of drug therapy.

Nearly all of the respondents (95%) said that new medications were needed, and 94% said patients would directly benefit from new drugs.

About four in five respondents disagreed with the statement that currently available medication options for schizophrenia are sufficient, and said that they had changed their patients' medication more than once in the past 12 months, with lack of efficacy being the primary reason for the switch.

The most important criterion for choosing a new antipsychotic for schizophrenia was efficacy, which was listed by 60% of respondents, Dr. Buckley said. That was followed by safety, tolerability, and adverse events, listed by 49%. The elimination of positive symptoms (delusions, hallucinations, suspiciousness and excitability) was cited as the primary criterion by 31% of respondents.

Still, Dr. Buckley said, nearly three-fourths of respondents (72%) said they would trade some degree of safety and/or tolerability for more efficacy.

Adherence problems were also common, he noted, with 79% of respondents reporting that their patients forget take their drugs at least occasionally.

The survey results suggest that the ideal agent for treatment of schizophrenia has yet to be discovered, Dr. Buckley said, and the need is there.

"While schizophrenia is not as common as something like hypertension, it nevertheless is debilitating," he said. "About 4% of people with schizophrenia end their lives by suicide. Certainly more than half of people of them attempt suicide, and, as you might imagine, hearing voices and seeing things, being paranoid and feeling that you're being controlled by outside forces are extremely distressing."

And, Dr. Buckley added, there are other symptoms that many people are not aware of-loss of expressiveness, lack of motivation, problems with self-care, and the general loss of a sense of enjoyment of life.

"There is an unmet need for effective treatment. Treatment that people feel will work for them and that they can tolerate. Treatment that they're willing to commit to and be able to take over time," Dr. Buckley said.