Overcoming Schizophrenia Treatment Challenges and the Potential of TAAR1

In this video taken at Psych Congress Elevate, Rebecca Kraus, MSPS, PA-C, psychiatric physician assistant at Southlake Psychiatry, Charlotte, North Carolina, explains common treatment challenges that clinicians encounter when treating patients with schizophrenia, barriers to accessing treatment, and the exciting potential of trace amine-associated receptor (TAAR1) agonists in treating psychosis.

Want to learn more about TAAR1 treatments for schizophrenia? Check out this video from Psych Congress 2021. 

Rebecca Kraus, MSPAS, PA-C, earned a Master’s Degree in Physician Assistant Studies from the University of Kentucky in 2012. A recommendation from a classmate and a whim took her to Charlotte, NC where she started her career as a PA-C in Neuropsychiatry. This is where she developed her passion for patient care and psychopharmacology. She has been at Southlake Psychiatry in Davidson, North Carolina since 2016, where she maintains full-time practice treating patients in the outpatient setting. She also underwent Buprenorphine training to provide medication assisted treatment for opioid dependence. She enjoys treating the full spectrum of psychiatric disorders including depression, anxiety, bipolar disorder, schizophrenia, obsessive compulsive disorders, gender dysphoria, eating disorders, and post traumatic stress disorders.

Read the Transcript: 

Rebecca Kraus, MSPAS, PA-C: I'm Rebecca Kraus. I'm a psychiatric physician assistant at an outpatient private practice in Davidson, North Carolina, Southlake Psychiatry.

With any disease state, there's going to be treatment challenges, but I think particularly with schizophrenia, some of the main ones I want to highlight are treatment resistance. Up to 30% of patients with schizophrenia are resistant to dopamine blockade, which is our primary mechanism of action that we use to target in treatment. Side effects: when we look at any treatment option, any medication, there is a risk of side effects. Unfortunately, with the medications that we use in schizophrenia, there's some severe side effects, big side effects, potentially life-threatening side effects, with things like neuroleptic malignant syndrome. Side effects that increase the risk of cardiovascular disease, contribute to higher rates of mortality.

Stigma. Particularly with mental illness across the board, there's stigma associated with the disease states in and of themselves, and then also with seeking treatment. With schizophrenia in particular, there's a lot of stigma around that disease state. Some of the major causes of underrecognition and undertreatment in schizophrenia, I broke that down into three separate categories, looking at insight, access, and advocacy. So as we are all well aware, schizophrenia is a psychotic disorder marked by delusions and hallucinations. If a patient doesn't have insight into the fact that there is a problem going on, are they going to even seek treatment? Oftentimes, people are getting treatment only when prompted by family members or through the criminal justice system, or through a hospitalization.

Looking at access, we know across the board as far as psychiatry, there's never enough access, particularly even more so since the pandemic. But if someone doesn't have insight into the fact that there is a problem, are they even going to get in to get the access? And then if they do realize that there is an issue, can they get in to see someone? And then beyond even getting in front of a clinician, when we look at some of the treatment options, are they affordable? Can someone even get them? Can we continue to get them? Can we get to our appointment? So I think access is a big part. And then we look at advocacy, so referencing again back to insight, are these patients going to advocate for themselves? Schizophrenia is a disease that's often sensationalized in the media. It's also a disease state that's not fully understood. So that lack of knowledge, we need advocates out there to support our patients getting treatment, getting diagnoses, getting the help that they need to improve their lives.

TAAR1 is a trace amine-associated receptor, and this is particularly exciting in the field of psychiatry, and especially schizophrenia, as our TAAR1 agonists have shown some really promising and exciting promise in treating psychosis without going through direct dopamine blockade. That's particularly exciting, because over the years, we have targeted the treatment of psychosis in schizophrenia through dopamine blockade, and the side effects associated with that have often been referred to as the cost of doing business. The side effects like movement disorders, hyperprolactinemia. So in addressing psychosis without directly blocking dopamine, we can avoid some of those side effects. Also, as I mentioned earlier, up to 30% of patients are resistant to dopamine blockade directly, so using a different novel mechanism of action can hopefully provide help for patients that have previously been considered treatment-resistant. And then when we look at the negative and cognitive symptoms of schizophrenia, those are often left unaddressed with our current treatment options, and the TAAR1 agonists are showing some really promising results in improving those symptoms.

The TAAR1 agonists are also showing promise in addressing some of the psychiatric comorbidities that we see with schizophrenia, and we know that up to 50% of people with schizophrenia also have a psychiatric comorbidity such as depression, anxiety, substance use. And if our goals are improvement in functional outcomes, we need to be addressing all the comorbidities. So it's really exciting with the TAAR1 agonists that we're seeing improvements in depression, some pro-cognitive benefits, some anti-addictive benefits.