Breaking the Cycle of Incarceration for Schizophrenia Patients [transcript] [audio]

Guest: Dr. Martha Sajatovic, MD

Presenter: Neal Howard

Guest Bio: Dr. Sajatovic is Director of the Neurological and Behavioral Outcomes Center at University Hospitals Cleveland Medical Center; Director of the Geropsychiatry Program at University Hospitals Cleveland Medical Center; and Professor of Psychiatry at Case Western Reserve University School of Medicine.

Dr. Sajatovic’s areas of expertise include anxiety, geriatric psychiatry, schizophrenia, bipolar disorder, depression, mood disorders, and adult psychiatry.

 Segment Overview: Dr. Martha Sajatovic discusses the PRIDE study and tells us and why is it important to break the cycle of incarceration, hospitalization and substance abuse for people with schizophrenia.

Transcript

Neal Howard: Welcome to the program. I’m your host Neal Howard. Glad that you could join us here today on Health Professional Radio. Our guest is Dr. Martha Sajatovic. She’s going to talk about a drug that has the potential to reduce rate of incarceration for patients with Schizophrenia and bringing hope to breaking that cycle of hospitalization and incarceration. Welcome to Health Professional Radio today Dr. Sajatovic. How are you?

Dr. Martha Sajatovic: I’m good. Thank you for having me.

N: First of all, very briefly, who is Dr. Martha Sajatovic? What do you and where do you do it?

S: Well a good question. I am a Professor of Psychiatry and of Neurology. I’m at Case Western Reserve University School of Medicine and also University Hospitals at Cleveland in Cleveland, Ohio.

N: I understand also that you’re a lead investigator with the PRIDE study. Can you tell us what the PRIDE study is?

S: The PRIDE study, a very exciting and in my opinion important project. It was a clinical trial for a research study which looked and specifically enrolled people who had a history of incarceration to being in jail or prison. Often one of the complications for people with Schizophrenia certainly can have, as you can imagine it definitely contributes to a poor outcome. Basically what the study did is, it enrolled or recruited people with Schizophrenia who had recent incarceration problems with the law and then they were randomly assigned, so basically kind of flipped off the coin, doubled over or more complicate on that, but basically that’s a gist of it. To receive either a one monthly injectable antipsychotic medication with medication called paliperidone palmitate versus antipsychotic medication that people take with pills. The study went for 15 months which is actually pretty long for this kind of research study. The primary outcome or what the research is really interested in looking at, was how long it takes for people to basically get in trouble or have a treatment failure, either being arrested again or incarcerated or being hospitalized, stopping treatment, kind of variety of real world outcomes stuff that I think everybody would agree is bad for people with Schizophrenia. What the PRIDE study show, is that the injectable medication was associated with better outcome so people were less likely to have those bad events or fair treatment failures. That’s a very important finding. These long injectable medications are available currently and clinicians have access. It really kind of opens up the door to thinking about using this medications in people who just turned out doing well or might have a poor prognosis.

N: These injectables are administered by the healthcare professional. It’s not left up to the patient to comply. That is correct, right?

S: That is correct. People do need to come to a clinic and get some medications. Although sometimes, some clinicians or health systems do outreach where they can have a visiting nurse, friends to come in and give medicine. That’s very exciting. It gives a lot more flexibility. People don’t have to worry about taking medications everyday. Then if there’s a problem, the health professionals there and they can be addressed right away.

N: What is it about a patient with Schizophrenia and incarceration for whatever reason committing some criminal act or being a danger to themselves or to others. I guess they wouldn’t be incarcerated. I guess they’d be hospitalized, but I am not aware. I don’t really know. What is it about Schizophrenia specifically that raises this interest in the cycle of incarceration as opposed to someone who’s just a career criminal?

S: Schizophrenia is an illness that usually happens early in life. The people get it in their teenage years usually or early 20s, maybe mid 20s. Although it can occur later on for the first time later in life. But usually with young people who often have an opportunity to get their education in, to accomplish any life goal. So now they’ve got this illness which tends to be chronic, they often can’t complete their school, then they have difficulty getting jobs because of their symptoms. They have a hard time with social interactions. Now it’s hard for them to work, to establish relationships. They may start using substances and you kind of see where that’s going. People start to accumulate difficulties in their life or challenges. Then it’s much more likely for them to fall into legal problems. Unfortunately, we see if it’ll get incarcerated, populations are present in the system. We tend to see a lot of people with mental illness and definitely with Schizophrenia as well.

N: You mentioned that it presents early in life. Are we talking a preadolescence?

S: That can happen. I mean, there are childhood onset versions of this condition but most of the time it would be as people are kind of entering adulthood – college, young adults. They might be young service members, if they’ve got into military. That tends to be the very vulnerable time period.

N: Did the study went any insight into earlier proper diagnosis when it comes to Schizophrenia? If its onset that early in life, I’m sure there is a period of misdiagnosis or no diagnosis, whatsoever.

S: The average age of people that were in the study, was around 38 years. These were people who are a little bit older and because of the study inclusion criteria, in other words the requirements for being enrolled in the study. A person would have already had to have some history of incarceration. Actually according to the protocol or the set of procedures, people would have had been taken into custody in the criminal justice system at least two times at the previous two years. That kind of steers you away from being able to save very much about very young people and kind of early intervention, based on the findings. But we do know from other work and other research that’s out there that the sooner you can identify Schizophrenia and the sooner that you can get people in the comprehensive treatment, the better their outcomes. The study compared basically the formulation that’s given, that’s a long acting injectable. So once a month treatment versus daily oral treatment with other also FDA approved and this medication is FDA approved. What really is the clincher here is that getting once monthly injection probably helps people stay on track and improve what would be otherwise a pro prognosis, compared to having to take a medication once or twice a day.

N: That directly relates to the compliance issue which seems to be a huge problem, especially in mental health patients.

S: It is. In Schizophrenia in particular, what we are learning increasingly is that people with Schizophrenia have problems with what’s called their cognition, sort of their ability to process information and kind of sometimes to solve problems or pay attention. There’s a variety, kind of more subtle cognitive impairments that we see. So that makes it harder to stay on track with medications.

N: How has the government view the study? If they view the study at all, in dealing with those who are incarcerated in various facilities around the country.

S: I think that remains to be seen so this medication got this FDA approval to include this in the prescribing information or the package, so it’s there. How that information placed out in the real world I think remains to be determined. I think what’s particularly remarkable about the study is that it was done. In most research studies, in to treat Schizophrenia, they would absolutely exclude this kind of research study, part of study. Somebody who’s not taking their medicines or have had legal problems, somebody who has substance use problems. Those people would be specifically excluded from that typical research studies in Schizophrenia. Here now, we have some finally some research information in a real world population that I think we can use to try to understand what is the potential implication for clinical care. Then potentially, payors might get involved, government education might get involved to say, “How can we get support what know here?”

N: I appreciate you talking with us today.

S: Thank you for having me.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the program are available at healthprofessionalradio.com.au and also at hpr.fm. You can subscribe to this podcast on iTunes, listen in and download a SoundCloud and be sure and visit our affiliates page at healthprofessionalradio.com.au and hpr.fm.

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