David Walling, PhD: Misconceptions and New Developments Around Schizophrenia

Schizophrenia, a long-term mental disorder involving a complex failure between thought, emotion, and behavior, can lead to symptoms such as faulty perceptions, inappropriate actions, and feelings, withdrawal from reality, as well as an overall sense of mental fragmentation. The condition affects roughly 1.1% of the global population over the age of 18, according to the National Institute of Mental Health, 3.2 million of which reside in the United States.

Despite this prevalence, the disorder is wildly misunderstood. At the American Psychiatric Associations’ annual meeting in New York City, David Walling, PhD, the CEO of the Collaborative Neuroscience Network, sat down with MD Magazine to talk about the biggest misconceptions about patients with schizophrenia—including the high rate of suicide among this patient population—and what’s being done to address them.

He also spoke about the most exciting developments for these patients that are in the works or being utilized outside of medications, including the advancements being made as a result of an intersection between genetics, technology, and medicine.

David Walling, PhD:

Oh boy, there are a lot of misconceptions about schizophrenia. I mean, a lot of my patients do have hallucinations and they do have delusions, but also a lot of them have what we call the “negative symptoms” of schizophrenia.

[In our presentation at APA 2018,] we talked about negative and positive symptoms. The positive is not because they're good, but [because] it's beyond what we would consider normal, such as hallucinations and delusions, suspiciousness, persecution, all of that. Then the negative symptoms are the absence of what we would consider normal, so it's the lack of relations with people, it's the lack of effect, the lack of ability to connect.

For a lot of people, they only think about the positive symptoms, but the negative symptoms are really incredibly devastating for patients and their families. The other thing [that isn’t discussed] is that the suicide rate in schizophrenia is quite high. People don't realize that this is a deadly illness—about 10% of individuals with schizophrenia will kill themselves within the first 5 years of diagnosis. It's really something that we need to take seriously, and I think doctors need to be looking for that when they're treating these patients, particularly in clinical trials.

The FDA has required now that we do suicide assessment at every visit with us [that] a subject [has]. We're also seeing that translate to some of the real world. So, for example, at my hospital, we do a formal suicide assessment—the Columbia Suicide Assessment Rating Scale—at every admission and discharge of a subject. I know other hospitals are [starting to do] that as well.

You know, apart from some of the medications, I was just at the Schizophrenia International Research Society meeting, in Florence, Italy, and you know, there's a lot of talk about genetics [and] I think that's kind of one of the areas that we're moving into. Although we've been looking at genetics for a long time, and we're still kind of hoping for the breakthroughs.

The other interesting thing I think that we're seeing is some of the [smartphone] apps that are being developed for schizophrenia. You know, [when] you think about schizophrenia, you don't normally think of your patients on a smartphone, using some of these apps, but some of the apps that are that are coming out are actually pretty cool. They're going not only help patients to maybe think more clearly, but there's cognitive behavior therapy apps and things like that [which are helpful].

Once a patient is stabilized on their medications, such as long-acting injectables, then you can start to work on the other things in their lives, such as their relationships with people and getting them engaged in activities, so I think you know, the medications are certainly exciting, and I've watched [them develop]. I've been an investigator for the last 26 years—I've seen all of the atypicals, from early development through late development and approval, so I do find them exciting, but I think that some of these other things [such as] the technology and using that with schizophrenia, is really going to be the wave of the future.

Transcript edited for clarity.

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