Pharm.D. (six years)
Pharmacy Practice (PHP)
psychiatry, pharmacy, schizoaffective, schizophrenia, adherence, treatment
Background: Schizophrenia is a disorder that is characterized by disordered thinking, memory, and perception in its patients. Schizoaffective disorder is a separate disorder that features symptoms of schizophrenia and mood disorders. Because of the overlap in symptoms, it is relatively easy to confuse schizoaffective disorder and schizophrenia. Based on DSM-5 criteria, patients with schizophrenia must have at least two of the characteristic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms) for a significant portion of time during a 1-month period and experience significant disturbance in functioning. A diagnosis of schizoaffective disorder can be made if that patient exhibits the symptoms required for schizophrenia in addition to presenting with a major mood episode. This major mood episode can include elevated and depressed moods similar to bipolar disorder, and their associated symptoms.
Schizophrenia and schizoaffective disorders are not preventable or curable disorders, but various treatments are available for symptomatic suppression. However, there are differences in how the two disorders are treated. Therefore, accurately diagnosing these two conditions is imperative to ensure patients receive the appropriate evidence-based treatment.
Objectives: To understand how diagnostic criteria on paper translates into real clinical practice and to develop interventions to improve the care of patients with schizophrenia and schizoaffective disorder.
Methods: We conducted semi-structured qualitative interviews with consenting psychiatrists at Cambridge Health Alliance sites to understand how they diagnosed and treated patients with either schizophrenia or schizoaffective disorders. We extracted data from the transcribed interviews and created frameworks of how each psychiatrist conceptualizes the diagnosis and treatment of these disorders. We then completed chart reviews for five of each psychiatrist’s patients who were diagnosed with either schizophrenia or schizoaffective disorder. Data from the chart reviews represented the real-world diagnosis and treatment of patients, which was then compared with the psychiatrists’ conceptualization of these disorders and their treatment.
Results: The results of this study have not been fully realized yet. The consenting psychiatrists have been interviewed and data has been collected from five of their schizophrenia and/or schizoaffective disorder patients. Analysis of the patients’ baseline characteristics has been completed, and we have determined which data markers would best illustrate differences in how both schizophrenia and schizoaffective disorder patients are diagnosed, treated, and prepared for functioning well in society after being discharged. We have also determined which data markers will be extrapolated from the psychiatrists’ interview responses in order to understand their beliefs regarding differences between the diagnosis, treatment and therapy adherence of these two conditions. We are in the final process of comparing corresponding data markers from both sources (psychiatrist interview and patient charts), which will allow us to determine how well psychiatrists translate their conceptualizations into real-world clinical practice.
Conclusion: As we have progressed through our data analysis, preliminary trends have become evident. The majority of psychiatrists did acknowledge a difference between the two conditions and this seems to be supported by their diagnosing and treatment habits. However, psychiatrists at this site did not draw distinctions when discussing the issue of patient adherence to their respective therapies.