Schizophrenia is a relatively rare, potentially debilitating brain disorder characterized by disrupted thoughts, perception, emotions, and social interactions. These usually appear as psychosis (loss of touch with reality), delusions, hallucinations, disorganized speech, and unusual or inappropriate behavior.
Schizophrenia usually presents and is diagnosed among people in their teens and twenties. While males tend to have earlier onset, the condition affects males and females at equal rates. Experts do not know the specific cause of schizophrenia, although there are a variety of risk factors such as genetics, environmental factors, and severe stress or trauma.
Schizophrenia and Substance Use Disorder
Although schizophrenia affects less than 1 percent of the population, an estimated 47 percent of people living with schizophrenia also struggle with substance use disorders (SUDs). Cannabis use in particular has been linked to earlier onset of schizophrenia and more severe positive symptoms.
Besides the dangers of SUD in general, such as harms to physical health and damaged relationships, SUD can create additional problems for individuals with schizophrenia. Substance misuse may worsen disease symptoms or lead to lack of medication adherence. SUD may encourage more self-destructive or violent behaviors, including self-harm, and may make a person with schizophrenia more vulnerable to mistreatment by others.
Currently, there is no cure for schizophrenia. However, there are various treatment methods that can ease symptoms and help affected individuals achieve greater quality of life and reduce the risk of recurrence. One new treatment in particular suggests an entirely different view of the disease.
New Potential Treatment for Schizophrenia
On September 26, 2024, the FDA approved oral Cobenfy (xanomeline and trospium chloride) capsules for the treatment of schizophrenia in adults. Unlike drugs that target dopamine receptors, this new drug from Bristol-Myers Squibb targets the brain’s cholinergic receptors. This makes Cobenfy the first approved drug in its class.
Until now, the standard of care for schizophrenia has been the use of drugs like Thorazine and Seroquel, which treat schizophrenia symptoms by blocking dopamine receptors, the chemicals used by the brain for communication. However, these drugs usually come with side effects such as tremors, drowsiness, and weight gain, or do not work at all for some patients.
A new medication option that does not have the same side effects may be more appealing to people affected by schizophrenia. It may also make it more likely that they will stay on the medication long-term, potentially leading to better disease outcomes. However, Cobenfy is not recommended for individuals with liver or kidney disease, and it may cause gastrointestinal side effects.
Researchers studied the effectiveness of Cobenfy in two 5-week, randomized, double-blind, placebo-controlled, multi-center studies. Study subjects included adults who were diagnosed with schizophrenia according to DSM-5 criteria. Participants who received the drug experienced “meaningful reduction in symptoms” over the five weeks, according to the Positive and Negative Syndrome Scale (PANSS).
Cobenfy works by activating two brain receptors involved in regulating memory and other roles in the central nervous system. (In fact, the drug was initially intended for Alzheimer’s disease.) Scientists hypothesized that these muscarinic acetylcholine receptors are more involved in cognitive functions than dopamine, making them better drug targets.
This drug offers the first new mechanism of treatment for schizophrenia in decades. The ability to reduce the potentially devastating symptoms of schizophrenia can make an enormous, positive difference in patients’ functioning and quality of life.
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