The meeting aimed to connect members of the entire mental-health team – psychiatrists, nurse practitioners, physician assistants, psychologists, primary care physicians, and other mental health professionals – with the foremost experts in psychiatry to improve patient outcomes through education.

Psych Congress 2022 provided a platform for practical insights to better personalize treatment strategies. This article highlights the key scientific sessions of interest.

Selected scientific sessions: general 

Jain R, Guinart D, and Zhou H – Broadening horizons: artificial intelligence and the future of digital health in psychiatry¹ | Teva-sponsored innovation theater

The presenters discussed challenges in the diagnosis and assessment of psychiatric and movement disorders including limited funding and resources, a lack of validated biomarkers, and an incomplete understanding of the mechanisms of onset and progression. While patient- and clinician-level barriers have limited implementation of artificial intelligence (AI)-based healthcare technologies in clinical practice, digital health technologies have numerous applications in mental healthcare. These include risk prediction and prevention, population health management, medical advice and triage, risk-adjusted paneling and resourcing, remote patient monitoring, diagnostics and treatment, chart review and documentation, digital health coaching, clinical decision-making, and practice management. Results from a cross-sectional global survey of psychiatrists on the potential for AI/machine learning (ML) to replace 10 key tasks in mental health practice demonstrated that 42.10% predict minimal influence and 47.41% predict moderate influence on the work of psychiatrists over the next 25 years.

“AI is not going to replace physicians, but physicians who use AI are going to replace physicians who don’t, and that may be a cautionary tale” - Keith A. Horvath, MD

Compton M, Armand C, and Chepke C – Breaking the cycle of social disparities, stigma, and isolation in people with neuropsychiatric disorders¹ | Teva-sponsored innovation theater

This session focused on the intersection of social disparities and neuropsychiatric disorders, and practical tips for how to account for them in clinical practice. Presenters discussed how systemic and individual biases may affect healthcare. Social determinants of mental health are the societal (e.g. integration, support systems, equality, discrimination, etc.), environmental (e.g. physical environment, safety, housing, transport, etc.), and economic (e.g. occupation and employment status, debt, medical bills, etc.) conditions that impact and affect mental health outcomes across the population. Dr. Compton discussed the complex relationship between social determinants of mental health and neuropsychiatric disorders, while Dr. Armand emphasized the need for clinicians to take a full social history of patients to fully understand how to best engage in care. Results from a survey of patients receiving inpatient and outpatient treatment for acute exacerbation of schizophrenia (SZ), demonstrated that stigma was the most common patient-reported barrier to medication adherence. During his presentation, Dr. Chepke highlighted that social, physical, vocational, psychological, and psychiatric domains must be considered to assess the impact of tardive dyskinesia (TD) on daily life and function.

Selected scientific sessions: tardive dyskinesia

Chepke C, Jain R, Williams K, and Yeiser B – Addressing persistent myths and misconceptions in tardive dyskinesia¹ | TD360™ session – supported by an independent educational grant from Neurocrine Biosciences and Teva

The expert panel discussed a number of myths and misconceptions associated with TD, specifically: 

1. TD is not a problem for most patients 

• Presenters noted that TD is in fact common in every practice with psychiatric patients

2. Abnormal Involuntary Movement Scale (AIMS) is too difficult and time-consuming

• It was highlighted that some payers require AIMS scores for vesicular monoamine transporter 2 (VMAT2) inhibitor coverage, and that AIMS scores enable measurement-based care and promote a systematic thought process 

3. Only a movement disorder specialist can treat TD 

• Presenters highlighted that psychiatric clinicians could diagnose and treat ~95% of patients with TD

4. VMAT2 inhibitors are “one-size-fits-all”

• It was emphasized that clinicians should customize the TD treatment to the individual needs of the patient.

Selected scientific sessions: long-acting injectables

Meyer J and Matthews D – Breaking down the barriers to utilizing long-acting injectable antipsychotics for schizophrenia management¹ | Teva-sponsored session

Session presenters suggested that every patient with schizophrenia (SZ) should be offered a long-acting injectable (LAI), especially early in the course of SZ treatment, as relapse increases risk of treatment resistance. In order to facilitate LAI conversations, the presenters suggested working with the patient to identify and understand their goals (job, relationship, school), their motivation to receive a diagnosis or antipsychotic (AP) treatment, and their treatment concerns. The presenters emphasized that LAIs represent an important tool that should be offered to all patients with SZ to help them reach their functional goals. They also noted that effective treatment depends on effective communication, and motivational interviewing skills can facilitate engagement and an optimal shared decision making process.

Selected scientific sessions: schizophrenia

Kane J, Rubio J, Citrome L, and Correll C – S.C.O.P.E.™: Schizophrenia Clinical Outcome Scenarios and Patient-Provider Engagement – an interactive digital platform to educate on schizophrenia care¹ | Teva-sponsored innovation theater

The presenters discussed and refuted some common myths regarding LAI use in SZ, including physicians/providers know when patients are nonadherent, patients do not accept or want an LAI, and LAIs are only appropriate for patients that have demonstrated nonadherence. A non-branded Teva educational tool: the S.C.O.P.E.™ platform was introduced during this session.  S.C.O.P.E.™ uses a heuristic approach to education, enabling the healthcare professional (HCP) users to discover or learn for themselves. HCPs can choose from 11 clinical scenarios with selected patient characteristics that allow users a “hands-on” interactive experience. The presenters concluded that HCPs should consider LAIs as a standard treatment option for SZ, and their benefits should be explained to patients at the beginning of treatment.

Explore the S.C.O.P.E.™ platform

Correll C – State of schizophrenia¹ | General session

Dr. Correll highlighted complications in SZ such as cardiometabolic burden and motor symptoms. He highlighted the number needed to treat (NNT) of APs in acute (n=4498, NNT=6) and maintenance (n=6392, NNT=3) treatment of SZ compared with other medication classes [e.g. metformin maintenance for prevention of type 2 diabetes mortality (n=12,840, NNT=31); aspirin maintenance for secondary prevention of severe cardiovascular disease event (n=17,000, NNT=67)], demonstrating the effectiveness of APs. Dr. Correll also discussed several studies that showed superior outcomes for LAIs over oral APs, including:

1. A network meta-analysis comparing relapse rates for APs vs placebo, showing that LAIs had the lowest relative risk ratio

2. A 2022 publication suggesting that LAIs provided superior relapse prevention to oral APs in stable patients who were washed out from their prior treatment

3. A 2021 meta-analysis that compared risk of treatment discontinuation for LAIs vs oral AP medication, showing that LAIs had the lowest risk of discontinuation

4. The PRELAPSE study published in 2020, which demonstrated, NNT was seven for a once-monthly LAI to prevent one relapse.

Summaries of selected posters: tardive dyskinesia

Leo S, Maughn K, Miller A, Shoaib S, and Reshef S – Tardive dyskinesia: epidemiological trends in US populations based on cross-sectional analysis of retrospective claims data¹ | Teva poster

TD prevalence by year, payer, AP type (for patients with ≥2 AP claims), and comorbidity (SZ, bipolar disorders, or mood disorders) was calculated using data from patients ≥18-years-old enrolled in the All-Payer Claims Database between 2016–2020. The yearly TD prevalence increased over time from 6.88 to 11.53 per 100,000 patients. This may be related to the aging population, expanded use of APs, improved clinician awareness of TD, and/or availability of new TD treatments in 2017. Less than 1% of patients with ≥2 AP claims in the database were diagnosed with TD, and it has been estimated that 20.7% to 30% of patients with a history of AP use will develop TD, suggesting that TD is underdiagnosed in the US.² The authors concluded that compared with other underlying conditions, patients with SZ that were treated with APs were more than twice as likely to have a TD diagnosis.

Vanderhoef D, Vanegas-Arroyave N, Manahan R, and Cicero S – Anticholinergics should not be used to treat tardive dyskinesia: insights from an expert panel of psychiatry and neurology healthcare professionals¹ | Neurocrine poster

Despite a lack of evidence and the availability of approved TD medications, anticholinergics are still commonly used to treat TD. Anticholinergics do not improve TD symptoms and may worsen them. VMAT2 inhibitors are recommended as first-line TD therapies in alignment with APA guidelines and expert consensus. The expert panel agreed that except for patients at high risk of acute dystonia, anticholinergics should not be used prophylactically to prevent DIMDs. A consensus was reached that the three following key population groups should avoid anticholinergics: patients older than 55 years, due to more pronounced cognitive side-effects; individuals with developmental disabilities, mild cognitive impairment, and dementia, due to worsening of cognitive impairment; individuals with a history of substance abuse or dependence, due to potential for abuse or diversion.

Summaries of selected posters: long-acting injectables

Correll C, Rubio J, Citrome L, Kane J, Mychaskiw M, Franzenburg K, Suett M, and Kotak S – Clinical dilemmas in schizophrenia treatment and the potential place in therapy of long-acting antipsychotic agents¹ | Teva poster

New educational initiatives targeting the most common dilemmas or issues faced by providers would potentially alleviate knowledge gaps and clarify the role LAIs may play in treating patients with SZ. A panel of four experts was formed to identify 10 key clinical dilemmas in which LAI treatment may be useful based on empirical evidence; settings include emergency departments and both inpatient and outpatient clinics. The S.C.O.P.E.™ framework includes considerations for: shared decision-making, monitoring of adverse effects, and the of alternative AP formulations when needed.

Velligan D, Salinas G, Belcher E, Franzenburg K, Suett M, Thompson S, and Hansen R – Understanding the use of long-acting injectable antipsychotic agents in schizophrenia: a 2022 survey of US psychiatrists, nurse practitioners, and physician associates¹ | Teva poster

A survey of 295 psychiatrists and 85 psychiatric nurse practitioners (NPs) and physician associates (PAs) was conducted to better understand key factors and attitudes underlying LAI utilization. Results showed that clinicians believed 53% of patients nationwide are nonadherent with oral APs and only 26% of their patients are nonadherent, suggesting that clinicians tend to underestimate the level of nonadherence among their patients. The survey results showed that 68% of clinicians continue to reserve LAIs for patients with adherence issues. Furthermore, more than half of clinicians were not confident about: initiating LAIs, managing side effects while a patient is taking LAIs, and transitioning patients who are stable from oral APs to LAIs.

Correll C, Rubio J, Citrome L, Kane J, Mychaskiw M, Franzenburg K, Suett M, and Kotak S – Dispelling myths and misconceptions surrounding the use of long-acting injectable antipsychotic agents for treatment of schizophrenia¹ | Teva poster

A panel of four experts was formed to collate common LAI myths and misconceptions held by HCPs that often leads to underutilization of LAIs. The panel challenged the myth that HCPs know when patients are nonadherent by showing that overestimation of adherence is common, and that poor adherence can be mistaken as treatment resistance. They also challenged the second myth that patients do not accept LAI treatment by showing data that HCPs may overestimate patient concerns about LAIs. The third myth challenged was that LAIs are only appropriate for patients who have demonstrated nonadherence by presenting guidelines and data that recommend LAIs should be used beyond cases of nonadherence and in early-stage SZ.

Citrome L, Geffner-Smith A, and Stewart M – Long-acting injectable antipsychotics: practical considerations and impact on adherence in schizophrenia¹ | Alkermes and Teva poster

This poster described the background, learning objectives and results of the LAI360 educational curriculum. The LAI360 program reached over 8,000 learners in total; data were available for 904 live learners; 35% were NPs, 30% were physicians, and the remainder included other professions such as pharmacists, social workers, PAs, registered nurses, and psychologists. Clinicians displayed low levels of knowledge regarding: the pharmacology of current medications, especially newly approved and investigational LAIs and implementation strategies for patient-centric communication to facilitate LAI uptake. From pre- to post-test, 67% of learners reported an increase in knowledge regarding LAI pharmacology, mechanisms of action, safety and efficacy, and administration concerns. The top-rated barriers to LAI utilization among learners were insurance and affordability.

Patel C, Pion D, Morrison L, Holiday C, Lafeuille MH, Lefebvre P, and Benson C – Continuity of care among patients newly initiated on second-generation oral or long-acting injectable antipsychotics during a schizophrenia-related inpatient stay¹ | Janssen Poster

There are limited real-world data on the continuity of care for patients with SZ initiated on atypical LAIs or oral atypical APs during a SZ-related inpatient stay. Readmissions within 7 and 30 days after discharge, outpatient visits, AP dispensing within 30 days of discharge, and AP adherence were evaluated between patients initiated on atypical LAIs and oral atypical APs during a SZ-related inpatient stay. Compared with oral atypical APs, patients initiated on atypical LAIs were: three times more likely to be adherent to any AP, 51% more likely to have a SZ-related outpatient visit within 30 days post-discharge, and less likely to visit the ER (26% fewer days during the 6-month period post-discharge).

Summaries of selected posters: schizophrenia

Correll C, Rubio J, Citrome L, Kane J, Mychaskiw M, Franzenburg K, Suett M, and Kotak S – Introducing S.C.O.P.E.™: Schizophrenia Clinical Outcome Scenarios and Patient-Provider Engagement – an interactive digital platform to educate on schizophrenia care¹ | Teva poster

A panel of four experts in SZ management used empirical evidence to identify 10 key clinical dilemmas where LAIs may be useful. The panel developed ‘S.C.O.P.E.™: schizophrenia clinical outcome scenarios and patient-provider engagement – an interactive digital platform to educate on schizophrenia care’, a heuristic tool for use by clinicians. S.C.O.P.E.™ includes considerations for shared decision-making and monitoring of adverse effects, and provides information on suggested LAIs, as well as applicable guidelines and peer-reviewed references. This educational tool can be used by clinicians treating patients with SZ, along with standard psychiatric evaluations in inpatient and outpatient settings, to help them manage common clinical dilemmas and understand the place LAIs have in SZ treatment.

Mychaskiw M, Nair S, Suett M, Elgart A, Merenlender-Wagner A, and Kotak S – Influence of cultural differences and genetic polymorphisms on schizophrenia management: an exploratory targeted literature review¹ | Teva poster

This study was designed to examine what factors should be considered when assessing the efficacy of new SZ therapeutics in US- and Asia-based populations. A targeted literature review examined cultural and genetic differences between patients with SZ from the US and Japan or China through a PubMed search of data published between 2011–2021. Results from the review showed that cultural factors such as societal stigma, AP use patterns, and sex differences may mediate differences in SZ management between the US, Japan and China. The results also demonstrated that genetic factors including single-nucleotide polymorphisms and variation in candidate genes may affect AP exposure, efficacy, and response to treatment between the US, Japan, and China. This exploratory targeted literature review found several factors that may influence cultural, hereditary, and regional differences in SZ management between US and East Asian populations.

Li P, Benson C, Geng Z, Seo S, Patel C, and Doshi J – State- and county-level antipsychotic utilization, healthcare resource use and costs, and of care among Medicare beneficiaries with schizophrenia in the United States¹ | Janssen poster

This study used data from 2019 Chronic Conditions Warehouse Medicare Part A, B, and D claims and beneficiary summary files to examine the regional variation in measures of quality of care and burden of SZ as measured by AP utilization, healthcare resource utilization, and costs at the state and county levels. The top five states that utilize LAIs were Arizona (33%), Alabama (31%), Utah (30%), North Carolina (30%), and South Carolina (30%). The authors concluded that there were large regional variations in LAI use, hospital admissions, readmissions, and costs, thus supporting the need for targeted improvement initiatives by state and local policy makers and mental health providers for patients with SZ.

References

1. 35th Psych Congress; September 17–20, 2022; New Orleans, LA.
2. Carbon M, et al. J Clin Psychiatry 2017;78:e264–78.

NPS-US-NP-01200