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Patient Selection and Holistic Treatment in Schizophrenia By Prof Bernhard Baune

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Prof Bernhard Baune, Ph.D., MD, MPH, FRANZCP, holds the Cato Chair and is Head of Psychiatry at the  University of Melbourne. In 2011, he was appointed as Chair of Psychiatry and Head of Discipline of Psychiatry at the University of Adelaide. Under his leadership, psychiatry research at the University of Adelaide gained international recognition for excellence in neuroimmunology and genomics of mental disorders, and for innovation in molecular and clinical underpinnings of personalized psychiatry. Prof Baune has authored or co-authored 204  peer-reviewed publications and 14 book chapters. 

So two more slides and then then i’m finished so looking at patient selection for you know looking at for example using certain treatments i think it’s important to look at those and if psychotic medications like the resident and others which have an improvement obviously on all row health outcomes not just a positive negative symptoms or antidepressant type

Symptoms but also improve you know general well-being physical well-being as well that gives us the best chance really to improve you know social outcomes in addition to biological outcomes here as well these are you’re very well familiar with so what is maybe an important part is to say well we have to cause symptoms we have also in addition to that cognitive

Symptoms emotional symptoms in schizophrenia which we need to address more holistically in addition to physical symptoms and i could show you the strategies for doing that i think we arrived really in our field at a very practical level that we now start to monitor this these changes we have medications available we have lifestyle interventions available

Nutrition available which improves those outcomes and what is important really at the practical level is to say well how do we communicate this so just measuring doesn’t help us and doesn’t help the patient in particular so we need to clarify and discuss with the gp what their expectations is whether they will do the monitoring whether they will continue with

The interventions or whether it will be the psychiatrist and what the what the regularity of that is and what the treatment goals there are so that’s really important to have a good communication here with gps here on that point so here thank you for your attention we have time for questions if you’re interested you can look for updates on twitter as well thank

You very much now it’s our opportunity for questions just to remind you that the speakers and i may at times to refer to off-label indications for various myths into the course of the day that’s not a course with the authorization of serbia but really part of our silent discourse and discussion about this so we’ve got a question here and here we are about the

Slides being email i think the case of talking with serbia representatives later will be the easy way to manage about that we just move on to the dose of an or as an iron yeah so you know i think the question is here 40 80 and 160 milligrams it really depends and we’ve seen the studies if you look at the the efficacy of the studies they use the range between

40 80 and 120 milligrams under 60 milligrams depending on the type of study higher doors are usually recommended obviously for for more efficacy in a tip psychotic effects but you know smaller dose may be in the long term medium type dose 80 milligrams might be you know efficacious as well so it really depends on the clinical situation but the whole range is

Obviously useful and their dosing issue is a kazusa dose dependent well not really not really there that the you don’t in terms of the side effect profile there’s not much dose dependence there pb is this thing i’m not sure i think there’ll be a matter for survey maybe a survey representative license evasion tell us when this magic is going to happen i suspect

When the compound falls into generic territory but hopefully sooner next question reversing weight gain which one is it sorry this one there what percent of people can reverse the weight gain on seizing olanzapine well it’s i think the effects as you have seen is quite dramatic so you see a lot of change in winwaker because with ratted on for example there is

No change in weight between baseline and week six week eight of the studies if you reduce it from orleans opinion you can actually reduce it depending on where you change to conducive from 30 40 50 % 2 0 depending on the type of medication switch to great about eeg a baseline yes though that that is recommended to do eeg at baseline the college recommends that at

At months 12 there was no recommendation to to the eeg again i would suggest to do an eeg once per year what you’re expecting from that what you’re looking for what is the reason for it or is it just engaging electro in careful arnold rivers and work yeah that’s that’s a that’s a good point to let’s just say you know i was trained first as a neurologist so i like

Eeg you know and i don’t know what what one can see in a g’s so looking looking at the the change in threshold for epileptic fits i think that’s an important part and we only can do that really if we do that more regularly and even from a neurological point of view you even twice per years not enough because you may actually miss that so therefore a little bit

Inclined to recommend it to do more regularly or on germinate toast tests too many tests yeah well too many tests depending on what type of tests i mean the as i said before looking at one test on you or one metabolic component only will not really inform the overall picture so therefore we need to you know take the box for various tests to get a global picture

And that’s been recommended as you can see it at least twice per year so it met baseline and year one follow-up but also in the meantime you know week 12 week 24 so it does it more regularly i think that’s really important and the costs for that okay that can be high for some patients if if not covered by health insurance but i think it’s worth the effort to do

That i’m a minimalist intent years one agent and try to use it well as exert that a third of people had more than one antipsychotic and there’s a question here about whether you are adding comorbidities and greater genetic risk rather than benefit well that that is the the the key clinical question what is the ratio between the benefit and the risk but i think

Once we get maybe a patient coming to us being on two or more medications we need to assess the benefit and the risk in these particular patients present is worthwhile if you’re a patient with schizophrenia enterprise exactly exactly so not assuming that the the skitty that pres symptoms or the anxious symptoms are just part of schizophrenia and and and go away

If the schizophrenia street the world that would be a limited view on increasing you know efficacy of medications why is most of a second line can you speak for the college yeah well well that the the guidelines i think when did they come out 2015 so at that time before the college guidelines for motor so that i think at that time the the drug was just had just

Started in australia in the early 2015 so maybe they didn’t have much data on that yet experienced yet but it may have changed i’m not sure it was the date about that so exactly yeah in the nineteen seventies there was real concern but antidepressants might worsen psychosis but there’s an issue question here which pacific antipsychotics worsened depression good

Question so which antipsychotic would worsen depression i think it you know you can’t globalize that answer because it really depends on the type of patient with depression and what type of patient that is whether they have agitation so in an agitated depressed patient and antipsychotic with you know some some so the effects on agitation might actually be helpful

Whereas in a patient obviously who has high personal ins you know antipsychotic with with no entire surgical effect might not help very much so it really depends on the type of symptoms the patient presents with but some antipsychotic may actually worse than the the effects ok we’ve got time for a couple questions about made for them to begin with met former

Where’s that question yeah on top wednesday well i’m a little bit cautious with metformin i know it’s used very widely but the the data base is very very thin and there is really no not much controlled studies of when to use metformin at one point in time for how long at what dosage so therefore i would be a little bit cautious with that to be honest and it’s like

Ari prefers all champagne an effects on cognition of anabolic yes as you have seen the the newer ones which are listed here are proposal a sinop in have a better metabolic profile overall and some of the data also suggests that there are positive effects on cognition as well so certainly these drugs and and resident for example are better from a metabolic profile

And hyperprolactinemia management well here again you know the management is obviously depending on the type of drug you’re using so using a drug which has a lower risk is probably more important so measuring prolactin levels is part of that not just going about risk factors but managing it includes also measurement and i think what i said today and with all the

Different data shown it really speaks to a measurement base you know approach to psychiatry rather than a risk based approach i’ll talk about poetic view of the last couple equations but there’s an important one here difference in lifestyle and lifestyle ardently in the in map intervention categories that’s right so lifestyle means that there was lifestyle plus

Anything else oh well i thought could be part of any type of you know additional interventions or lifestyle only and life salone was used in twenty three percent of the cases whereas lifestyle more generally and that’s encouraging as an intervention in addition to medications has been used in more than eighty percent of the cases so that is really encouraging

That lifestyle is has become part of our approach to mental illness and here in schizophrenia particular as you can see there are more questions there gave me more questions game through the day unfortunately professor binder not gonna be able to stay i know you’ve got a plane to catch i hope they have a super refreshments on that reflect lane for you thanks very much you

Transcribed from video
Patient Selection and Holistic Treatment in Schizophrenia By Prof Bernhard Baune By Dr Sanil Rege’s Hub – Psychiatry Simplified