Philippine Psychiatric Association

Of schizophrenia, medical breakthrough and safe treatments
By Earl D.C. Bracamonte

Ron Howards’ Academy Award-winning film “A Beautiful Mind” gave viewers a vicarious ride on how brain disorder can get the better even to the most brilliant of scientists. The 2001 Best Picture showed how the love and concern of family brought John Nash (Ed Harris) back from the darkness unto normalcy.
But it was Daniel Petrie’s 1976 opus “Sybil” that gave face to the mysterious mental illness we all come to know as schizophrenia. As the titular character, Sally Field is outstanding in this deeply disturbing but utterly fascinating drama of a young woman whose intense psychological childhood trauma has given her seventeen distinct personalities. Joanne Woodward plays the patient, dedicated shrink who sorts it all out. Like “A Beautiful Mind,” Sybil’s story was culled from true-to-life tales; and rings truest to one person in every one hundred.
Schizophrenia is a chronic, severe, and disabling brain disorder that seriously impairs a person’s ability to think clearly, relate to others and to function productively in society. While it is not known exactly what goes wrong inside the brains of people suffering the condition, the consequences of the disorder include difficulties in thought processes leading to hallucinations, delusions, disordered thinking, and unusual speech or behavior. All these symptoms mean that many people affected with the illness find it difficult to interact with other people, and may withdraw from the outside world.
This mental ailment affects men and women equally. It occurs at similar rates in all ethnic groups around the world. Symptoms such as hallucinations and delusions usually start between ages 16 and 30. Men tend to experience symptoms a little earlier than women. While most males first become ill between the ages of 16 and 25, the majority of females develop symptoms between the ages of 23 and 36.
While there is no cure for schizophrenia, many people with the illness respond well to antipsychotic drugs, the mainstay of treatment for the condition. The most effective way to treat it is with a combination of medication, psychological counseling and psychosocial education to help patients manage the impact of the illness on their daily lives.
Diagnosing schizophrenia is a delicate and complicated process and should be performed by a psychiatrist, who’ll interview the patient about their symptoms, how long they have had them, and the impact on their functioning. “Caucasians are more open with this condition. In fact, some think it’s an ‘in-thing’ to have couch sessions. Here, stigma still plays a big role in hindering treatment. More often, it is the patient’s family members who withhold important case history information. In the States, you will hear stories you’ll never read even in fictional works,” shared Dr. Myrna Astillero, a New York-based psychiatrist who’s now doing practice here in Metro Manila.
A number of medications are available for treatment and the most popular of which are ‘antipsychotics,’ the first medications which were developed. The newer generation of antipsychotics is called ‘atypical antipsychotics’ and it generally produces fewer side-effects. Also, antipsychotic medications are not addictive. Both ‘typical’ and ‘atypical’ antipsychotics are available in oral or long-acting injectable forms.
Schizophrenia is a highly debilitating condition and clearly the support of loved ones and other interested parties can have a significant impact to those living with it. People with schizophrenia benefit greatly when they let their family and friends help. “Family support is important. This is not something to be ashamed of. Treat it like any other type of disease which has its own symptoms and cure,” enthused Chinky Pinili, mother of teenage son Kevin who’s coping well with his medication; a once-a-month injectable called paliperidone palmitate, an atypical antipsychotic that has demonstrated efficacy and tolerability in both the acute and maintenance treatment of schizophrenia.
The Philippine Psychiatric Association (PPA) is the duly recognized non-stock, non-profit, professional organization of Filipino psychiatrists committed to the welfare of its members and to the advancement of mental health care, education, advocacy and research in the Philippines and the global community.
“The PPA holds an annual convention every January and a graduate course program every July. After Medical school, doctors go on to their post-graduate internship (PGI) prior to taking the Board exam. They then undergo three to four years of residency training before the diplomate board exams where they become Board-certified after passing. At present, we have almost 400 members including residents in training,” revealed child psychologist and incumbent vice-president Dr. Japhet Fernandez De Leon.
Since its nascence in 1973, the PPA embarks, annually, on forums relevant to their practice. This year, they assembled at the Crowne Plaza Ballroom for a conference billed “New Approaches and Possibilities for Patients with Schizophrenia and their Families.”
In his keynote speech entitled “Preserving the Future: Early and Sustained Intervention,” Prof. Robin Elmsley (M.D.) advocated for a continuous antipsychotic treatment. “There must be uninterrupted treatment for a long period of time. There are now unfamiliar concepts as well as changes in the way of treatment to make a difference. It is necessary to intervene as early as possible; preferably on the first acute episode between the ages of 20-30. The importance of early recognition and intervention keeps patients better. The first 2-5 years and the post-diagnosis treatments are critical in setting the parameters of long-term outcomes. Relapse rates are high after the first few episodes of schizophrenia. The strongest predictor of relapses is discontinued treatment.
“As the gray matter decreases so does the number of hospitalizations in most patients. Non-adherence is the problem at the onset of treatment for many. Recurrence is abrupt and severe. There are no tell-tale signs prior to attacks. Remission is necessary. The advantages of using an injectable far outweigh the disadvantages. Long-acting injectable (LAIs) are effective as they’re being used extensively worldwide. It is even more effective when used during early manifestations of psychosis. Environmental and pre-natal factors combine with neurodevelopmental genes can lead to psychosis,” elucidated the South African professor, who teaches at the University of Stellenbosch in Cape Town.
Paliperidone palmitate is marketed by Jannsen Pharmaceutica, a division of Johnson & Johnson (Philippines), Inc. It is the first and only once-monthly atypical long-acting injectable (LAI) in the Philippines for psychiatric treatment, and is available in 50, 75, 100, and 150mg doses. The prefilled syringes require neither refrigeration nor reconstitution.
In her report, Dr. Fan Zhang, medical affairs director (CNS) for Jannsen Pharma J&J in the Asia-Pacific concurred that the first five years is the most critical because treatment allows patients to gain normalcy. “Otherwise, relapse leads to bottoming out. In patients without prior medication, a window of 2-3 days hypersensitivity test is recommended,” said the Chinese practitioner in her report entitled “Evolution of Treatment Needs & Options in Management of Schizophrenia.”
Based in Belgium, Jannsen Pharmaceutica N.V. was established in 1953 by the young medical doctor, Dr. Paul Jannsen. Five years later, he discovered haloperidol, which presented a breakthrough in the treatment of schizophrenia. Unlike most pharmaceutical companies, it was created not as a subsidiary of a chemical factory but solely with the aim of conducting pharmacological research.
In 1961, The Belgian pharmaceutical company was acquired by Johnson & Johnson and is now part of their worldwide research and development center, the J&J pharmaceutical research and development (PRD), which conducts research and development activities related to a wide range of human medical disorders including mental illness, neurological diseases, anesthesia and analgesia, gastrointestinal disorders, fungal infection, allergies and cancer. It has five decades of dedication to Psychiatry, and their searches for better treatments still go on.
The Philippine Food & Drug Administration (PFDA) approved paliperidone palmitate as a once-monthly atypical antipsychotic injectable for the treatment of schizophrenia and for the prevention of the recurrence of its symptoms in February 2011. It has also been approved in the United States, Europe, Australia, Canada, India, Korea, Malaysia, Singapore, Hong Kong, Mexico, New Zealand, Guatemala, Colombia, and Israel.