Vol. 22, No. 4 / November 2010

Differential Diagnosis and Therapeutic Management of Schizoaffective Disorder

Date of Release: October 1, 2010
Date of Credit Expiration: September 30, 2011

DISCLOSURES

Joseph F. Goldberg, MD: AstraZeneca (Speaker’s Bureau); Cephalon, Inc. (Consultant); Eli Lilly and Company (Speaker’s Bureau, Consultant); GlaxoSmithKline (Speaker’s Bureau); Janssen-Cilag (Lecture); Merck & Co., Inc. (Speaker’s Bureau); Pfizer Inc. (Speaker’s Bureau)

Henry A. Nasrallah, MD: AstraZeneca (Speaker’s Bureau, Consultant); Forest Pharmaceuticals (Grants/Research); Janssen (Speaker’s Bureau, Consultant, Grants/Research); Merck & Co., Inc. (Speaker’s Bureau, Consultant); Novartis (Speaker’s Bureau, Consultant); Otsuka Pharmaceuticals (Grants/Research); Pfizer Inc. (Speaker’s Bureau, Consultant); Sepracor/Sunovion (Speaker’s Bureau, Consultant); Shire Pharmaceuticals (Grants/Research)

Christoph U. Correll, MD: Consultant and/or advisor to or received honoraria from Actelion Pharmaceuticals; AstraZeneca; Boehringer Ingelheim; Bristol-Myers Squibb; Cephalon, Inc.; Eli Lilly and Company; GlaxoSmithKline; Hoffmann- La Roche; Intra-Cellular Therapeutics; Janssen; Lundbeck Inc.; Medicure; Otsuka Pharmaceuticals; Pfizer Inc.; Schering-Plough; Sepracor/Sunovion; Supernus Pharmaceuticals; Takeda; Vanda Pharmaceuticals Inc.

Christopher Ontiveros, PhD (Medical Writer): Has no conflict of interest(s) to report

Jointly sponsored by Albert Einstein College of Medicine, Montefiore Medical Center, and Asante Communications, LLC.

This activity is supported by an educational grant from Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil-Janssen Scientific Affairs, LLC.

ACTIVITY GOAL

The goal of this activity is to educate psychiatrists and other health care professionals on best practices in the assessment, diagnosis, treatment, and ongoing care of patients with schizoaffective disorder.

LEARNING OBJECTIVES

At the conclusion of this program, participants will be better prepared to:

1. Conduct initial and ongoing assessment of patients with schizoaffective disorder (SAD), identifying comorbidities, current and prior medical history, and treatment goals

2. Diagnose SAD, differentiating it from schizophrenia, bipolar disorder, and major depressive disorder

3. Design and implement an appropriate multimodal treatment plan tailored to the patient’s SAD subtype and medical comorbidities

4. Implement psychosocial and psychopharmacologic interventions shown to improve treatment outcomes in patients with SAD

5. Utilize psychosocial and pharmacologic strategies to improve treatment adherence among patients with SAD

INTENDED AUDIENCES

This activity is intended for psychiatrists and other health care professionals interested in improving their knowledge base and skill sets in the individualized assessment and management of patients with schizoaffective disorder.

STATEMENT OF NEED

Patients with SAD must satisfy the criteria for both schizophrenia and either a major depressive episode or a manic/mixed episode.³ The prevalence of SAD has been estimated at nearly 1% of the US population.³ Although first characterized nearly 80 years ago, the evidence base supporting differential diagnosis and therapeutic management is limited. Clinical studies have frequently evaluated heterogeneous patient populations. Consequently, much of the guidance for diagnostic and therapeutic management derives from studies of schizophrenia, a similar but nevertheless distinct disorder.⁷

Schizoaffective disorder remains difficult to define, monitor, and treat. Long-term evaluation of patients with SAD, in particular, presents distinct challenges, not least because of its often evolving symptomatology.⁴ Diagnostic changes are not unusual and require tight clinical management. The paucity of peer-reviewed evidence specifically addressing this clinical construct confounds treatment, however. Recent scientific and clinical advances in our understanding of SAD risk factors, pathogenesis, and management highlight an important need among psychiatrists for peer-to-peer education.

LEARNERS GAP

Patients with SAD meet criteria for schizophrenia, while also meeting criteria for major depressive disorder or mania, and will have periods of psychosis without mood disorder symptoms. SAD remains underdiagnosed in part because it is frequently confused with other psychiatric disorders with overlapping diagnostic criteria—chiefly schizophrenia, bipolar disorder, and major depressive disorder. Understanding the collaborative management of patients with SAD is an important educational imperative for psychiatrists and other health care professionals. Considerable gaps in level-1 evidence mirror the need for psychiatrists to exchange insights into this heterogeneous clinical construct and its clinical management.

ACCREDITATION STATEMENT

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Albert Einstein College of Medicine and Montefiore Medical Center and Asante Communications, LLC. Albert Einstein College of Medicine is accredited by the ACCME to provide continuing medical education (CME) for physicians.

CREDIT DESIGNATION

Albert Einstein College of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CONFLICT OF INTEREST STATEMENT

The Conflict of Interest Disclosure Policy of Albert Einstein College of Medicine requires that faculty participating in any CME activity disclose to the audience any relationship(s) with a pharmaceutical, product, or device company. Any presenters whose disclosed relationships prove to create a conflict of interest with regard to their contribution to the activity will not be permitted to present.

Albert Einstein College of Medicine also requires that faculty participating in any CME activity disclose to the audience when discussing any unlabeled or investigational use of any commercial product or device not yet approved for use in the United States.

Joseph F. Goldberg, MD: AstraZeneca (Speaker’s Bureau); Cephalon, Inc. (Consultant); Eli Lilly and Company (Speaker’s Bureau, Consultant); GlaxoSmithKline (Speaker’s Bureau); Janssen-Cilag (Lecture); Merck & Co., Inc. (Speaker’s Bureau); Pfizer Inc. (Speaker’s Bureau).

Henry A. Nasrallah, MD: AstraZeneca (Speaker’s Bureau, Consultant); Forest Pharmaceuticals (Grants/Research); Janssen (Speaker’s Bureau, Consultant, Grants/Research); Merck & Co., Inc. (Speaker’s Bureau, Consultant); Novartis (Speaker’s Bureau, Consultant); Otsuka Pharmaceuticals (Grants/Research); Pfizer Inc.(Speaker’s Bureau, Consultant); Sepracor/Sunovion (Consultant); Shire Pharmaceuticals (Grants/Research).

Christoph U. Correll, MD: Consultant and/or advisor to or has received honoraria from Actelion Pharmaceuticals; AstraZeneca; Boehringer Ingelheim; Bristol-Myers Squibb; Cephalon, Inc.; Eli Lilly and Company; GlaxoSmithKline; Hoffmann- La Roche; Intra-Cellular Therapeutics; Janssen; Lundbeck Inc.; Medicure; Otsuka Pharmaceuticals; Pfizer Inc.; Schering-Plough; Sepracor/Sunovion; Supernus Pharmaceuticals; Takeda; Vanda Pharmaceuticals Inc.

Christopher Ontiveros, PhD (Medical Writer): Has no conflict of interest(s) to report.

Albert Einstein College of Medicine and Montefiore Medical Center, Center for Continuing Medical Education (CCME) staff, and the staff of Asante Communications, LLC, have no conflicts of interest with commercial interests related directly or indirectly to this educational activity.

The staff at Albert Einstein College of Medicine has no disclosures to report other than the following:

Steven Jay Feld, or a member of his household, owns securities in Bioheart, Inc.; Chelsea Therapeutics, Inc.; and Pharmacopeia, Inc.

METHOD OF PARTICIPATION

There are no fees for participating in and receiving credit for this activity. Participants should complete the activity, the self-report credit form, posttest, and activity evaluation form on pages S11 and S12 and mail to CCME, 3301 Bainbridge Avenue, Bronx, NY 10467, or fax to (718) 798-2336. A score of at least 70% is required to successfully complete this activity. Certificates will be mailed approximately 6 to 8 weeks after receipt of mailed submissions and verification of a passing grade. Online participation is also available via www.psychclinician.com/education (availability may be delayed from original print date). Enter the activity title in the search field to access the activity directly. Credit is available through September 30, 2011.

COPYRIGHT INFORMATION

Copyright ©2010 Albert Einstein College of Medicine and Montefiore Medical Center and Asante Communications, LLC. All rights reserved. No part of this monograph may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.

Annals of Clinical Psychiatry ©2010 Quadrant HealthCom Inc.