What Most People Get Wrong About Schizophrenia

So why the confusion? For starters, women tend to be diagnosed later in life, often during their late 20s and early 30s or even after 45, whereas men typically develop symptoms in their late teens and early 20s. Experts have speculated that estrogen may play a protective role, which would explain why some women don’t exhibit symptoms until perimenopause, when their hormones begin to fluctuate.

Whatever the reasons, the misconception that women are less likely to develop schizophrenia may delay their diagnosis and treatment.

Misconception 2: If you had schizophrenia, you’d know it.

Symptoms of schizophrenia include:

• Hallucinations, or when you sense things such as visions, sounds, or smells that seem real but are not
• Delusions, or when you have strong, irrational beliefs that can be easily disproven by others
• Disorganized thinking and speech, or being “all over the place”
• Difficulty completing cognitive tasks or activities, such as problem-solving, decision-making, or processing auditory information
• Memory problems
• Lack of emotion, or showing emotion that’s inappropriate for a given situation
• Paranoia

All that said, schizophrenia is a complex and serious illness. Many mistakenly believe that its symptoms are obvious and immediate, but that’s not always the case.

According to King, the onset of schizophrenia is usually gradual, and symptoms could be attributed to other stress or mood disorders or to substance abuse. This is especially the case among women, who in particular may experience affective symptoms like heightened emotions, depression, or impulsivity long before the more recognizable schizophrenia symptoms such as hallucinations or paranoia appear. Such gradual symptoms may increase the chance of misdiagnosis as they are similar to symptoms of other mood disorders. Additionally, some may delay seeking help to avoid the stigma of a diagnosis, which ultimately prevents them from getting early intervention and can make the condition harder to manage over time.

Even hallucinations, delusions, and paranoia aren’t always obvious, particularly in the early stages. “Hallucinations aren’t always out of context,” King says. “It can be as subtle as thinking you see something out of the corner of your eye that’s not there. And paranoia can start as thinking your spouse is cheating on you.”

Misconception 3: Schizophrenia is caused by drug use.

While substance use can exacerbate symptoms in people who are predisposed to schizophrenia, it does not cause the condition. For example, in a study evaluating the impact of marijuana use on young adults, it was shown that marijuana may affect those at high risk for psychosis differently than other users. Schizophrenia is a complex and chronic brain disorder with a complicated interplay of genetic and environmental factors.

Substances such as methamphetamines can mimic its symptoms by increasing dopamine levels in the brain, but these effects are distinct from the chronic, ongoing symptoms of schizophrenia itself. “It’s important that we look at substance abuse when making a diagnosis,” King says. “When someone presents with paranoia and hallucinations, it can be easy to assume this patient has undiagnosed schizophrenia, when in reality they are dealing with substance abuse.” The reverse can also be true—some patients may seem like they are dealing with substance abuse, when the root problem is that they have undiagnosed schizophrenia.

Further complicating matters, some people with schizophrenia self-medicate with such substances, thereby blurring the lines between the symptoms caused by the disease and those caused by the drugs. “Sometimes these issues exist together,” King says.

Misconception 4: People with schizophrenia tend to be violent.

One of the most damaging myths about schizophrenia is that those who suffer from it are prone to violence. While the paranoia and hallucinations associated with the condition can be frightening and disorienting, they rarely lead to violence. In fact, many people with schizophrenia struggle with their symptoms in ways that make them especially vulnerable. “People with schizophrenia are much more likely to be the victims than the perpetrators in situations of violence,” King says.

Misconception 5: People who don’t take their schizophrenia meds are defiant.

Non-adherence to treatment is a common challenge in schizophrenia care, but it’s not always due to defiance or a lack of willpower. There are many reasons someone might stop taking their medication. Side effects, such as fatigue, increased cholesterol levels, and weight gain, are one (although King notes that these can often be managed with dosing adjustments). Cognitive difficulties inherent to the disease can also make it difficult to remember to take a daily pill. And for some, the very symptoms of the illness—such as paranoia—can lead them to believe that the medication is harmful. Similarly, after a patient is treated for a period of time, they may feel as though they are completely cured, which could also lead to non-adherence. Like any chronic condition, schizophrenia requires consistent treatment over time.

There is also a greater likelihood that people with schizophrenia are dealing with co-existing conditions and social challenges that make adhering to a treatment regimen difficult. “A lot of my patients are living without housing,” King says. “When you’re trying to worry about keeping your family safe and trying to feed everybody, sometimes the last thing on your mind is going to the pharmacy.”

Misconception 6: A daily pill is the only option for treating schizophrenia.

This used to be the case, but not anymore. Now long-acting injectables (LAIs), such as ones made by Johnson & Johnson (J&J), are used to treat schizophrenia. INVEGA SUSTENNA^® (paliperidone palmitate 1-month) is an LAI that is administered by a healthcare professional just once a month after two starting doses, making it a potential treatment choice for adult patients who may have trouble remembering to take a daily oral medication. There are even LAI options from J&J for some appropriate adult patients that are administered every three or six months, such as INVEGA TRINZA^® (paliperidone palmitate 3-month) and INVEGA HAFYERA^® (paliperidone palmitate 6-month), the longest dosing-interval options available.

In fact, INVEGA SUSTENNA has also been proven to be more effective than a group of oral medications. In a research study, after 15 months of treatment, adult patients using INVEGA SUSTENNA had a 30 percent lower risk of relapse than those taking oral medication. And those who did relapse had longer times before relapse: These adult patients went an average of 416 days until their first relapse, compared with 226 days for the group taking daily pills. The most common side effects of INVEGA SUSTENNA seen in this study were:

• Injection site reactions
• Insomnia
• Weight gain
• Feeling restlessness or needing to be constantly moving
• Anxiety

“I really do believe in LAIs,” King says. “I have seen them make such a difference in the lives of some of my patients.”

Misconception 7: If you take medication for schizophrenia, you can skip the psychotherapy.

Medication is a critical component of managing this condition, but it’s not the whole picture. While antipsychotic medications (whether oral or LAIs) help regulate the chemical imbalances in the brain, various types of therapy, such as cognitive therapy, talk therapy, or group therapy, can also play a vital role in helping individuals manage their symptoms.

Therapy can empower patients with the tools they need to navigate daily life and maintain stability. “Medication can really help patients to think clearly enough to participate in supportive therapy,” King says. “And therapy can help patients challenge their delusions, and also help people regain confidence in their abilities once their symptoms are under control.”

If you or someone else you know may be experiencing schizophrenia symptoms, seek help—and for adult patients who have been recently diagnosed or have tried various treatments, consider speaking with a psychiatric nurse practitioner or other psychiatric professional about LAIs from J&J like INVEGA SUSTENNA. For more information on this medication, visit treatyourschizophrenia.com.

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INDICATIONS

INVEGA HAFYERA^® (6-month paliperidone palmitate) is a prescription medicine given by injection every 6 months by a healthcare professional and used to treat schizophrenia. INVEGA HAFYERA^® is used in adults who have been treated with either:

• INVEGA SUSTENNA^® (paliperidone palmitate) a 1-time-each-month paliperidone palmitate extended-release injectable suspension for at least 4 months
• INVEGA TRINZA^® (paliperidone palmitate) a 1-time-every-3-months paliperidone palmitate extended-release injectable suspension for at least 3 months

INVEGA TRINZA^® is a prescription medicine given by injection every 3 months by a healthcare professional and used to treat schizophrenia. INVEGA TRINZA^® is used in people who have been adequately treated with INVEGA SUSTENNA^® for at least 4 months.

INVEGA SUSTENNA^® is a prescription medicine given by injection by a healthcare professional.
INVEGA SUSTENNA^® is used to treat schizophrenia in adults.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^®?

INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® may cause serious side effects, including:

• Increased risk of death in elderly people with dementia-related psychosis. INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® increase the risk of death in elderly people who have lost touch with reality (psychosis) due to confusion and memory loss (dementia). INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® are not for the treatment of people with dementia-related psychosis.

Do not receive INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^® if you are allergic to paliperidone, paliperidone palmitate, risperidone, or any of the ingredients in INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®. See the end of the Patient Information leaflet in the full Prescribing Information for a complete list of INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® ingredients.

Before you receive INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®, tell your healthcare professional about all your medical conditions, including if you:

• have had Neuroleptic Malignant Syndrome (NMS)
• have or have had heart problems, including a heart attack, heart failure, abnormal heart rhythm, or long QT syndrome
• have or have had low levels of potassium or magnesium in your blood
• have or have had uncontrolled movements of your tongue, face, mouth, or jaw (tardive dyskinesia)
• have or have had kidney or liver problems
• have diabetes or have a family history of diabetes
• have Parkinson’s disease or a type of dementia called Lewy Body Dementia
• have had a low white blood cell count
• have had problems with dizziness or fainting or are being treated for high blood pressure
• have or have had seizures or epilepsy
• have any other medical conditions
• are pregnant or plan to become pregnant. It is not known if INVEGA HAFYERA^®, INVEGA TRINZA^®or INVEGA SUSTENNA^® will harm your unborn baby
  o If you become pregnant while taking INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®, talk to your healthcare professional about registering with the National Pregnancy Registry for Atypical Antipsychotics. You can register by calling 1-866-961-2388 or visit http://womensmentalhealth.org/clinical-and-research-programs/pregnancyregistry.
  o Infants born to women who are treated with INVEGA HAFYERA^®,
  INVEGA TRINZA^® or INVEGA SUSTENNA^® may experience symptoms such as tremors, irritability, excessive sleepiness, eye twitching, muscle spasms, decreased appetite, difficulty breathing, or abnormal movement of arms and legs. Let your healthcare professional know if these symptoms occur.
• are breastfeeding or plan to breastfeed. INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^® can pass into your breast milk. Talk to your healthcare professional about the best way to feed your baby if you receive INVEGA HAFYERA^®, INVEGA TRINZA^®
  or INVEGA SUSTENNA^®.

Tell your healthcare professional about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® may affect the way other medicines work, and other medicines may affect how INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® works.

Your healthcare provider can tell you if it is safe to receive
INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^® with your other medicines. Do not start or stop any medicines during treatment with INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^® without talking to your healthcare provider first. Know the medicines you take. Keep a list of them to show to your healthcare professional or pharmacist when you get a new medicine.

Patients (particularly the elderly) taking antipsychotics with certain health conditions or those on long-term therapy should be evaluated by their healthcare professional for the potential risk of falls.

How will I receive INVEGA HAFYERA^®, INVEGA TRINZA^® or
INVEGA SUSTENNA^®?

• Follow your treatment schedule exactly as your healthcare provider tells you to.
• Your healthcare provider will tell you how much you will receive and when you will receive it.

What should I avoid while receiving INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®?

• INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® may affect your ability to make decisions, think clearly, or react quickly. Do not drive, operate heavy machinery, or do other dangerous activities until you know how INVEGA HAFYERA^®, INVEGA TRINZA^®
  or INVEGA SUSTENNA^® affects you.
• Avoid getting overheated or dehydrated.

INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^® may cause serious side effects, including:

• See “What is the most important information I should know about
  INVEGA HAFYERA^®, INVEGA TRINZA^® and INVEGA SUSTENNA^®?”
• stroke in elderly people (cerebrovascular problems) that can lead to death
• Neuroleptic Malignant Syndrome (NMS). NMS is a rare but very serious problem that can happen in people who receive INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®. NMS can cause death and must be treated in a hospital. Call your healthcare professional right away if you become severely ill and have any of these symptoms: high fever; severe muscle stiffness; confusion; loss of consciousness; changes in your breathing, heartbeat, and blood pressure.
• problems with your heartbeat. These heart problems can cause death. Call your healthcare professional right away if you have any of these symptoms: passing out or feeling like you will pass out, dizziness, or feeling as if your heart is pounding or missing beats.
• uncontrolled movements of your tongue, face, mouth, or jaw (tardive dyskinesia)
• metabolic changes. Metabolic changes may include high blood sugar (hyperglycemia), diabetes mellitus and changes in the fat levels in your blood (dyslipidemia), and weight gain.
• low blood pressure and fainting
• changes in your blood cell counts
• high level of prolactin in your blood (hyperprolactinemia).
  INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^® may cause a rise in the blood levels of a hormone called prolactin (hyperprolactinemia) that may cause side effects including missed menstrual periods, leakage of milk from the breasts, development of breasts in men, or problems with erection.
• problems thinking clearly and moving your body
• seizures
• difficulty swallowing that can cause food or liquid to get into your lungs
• prolonged or painful erection lasting more than 4 hours. Call your healthcare professional or go to your nearest emergency room right away if you have an erection that lasts more than 4 hours.
• problems with control of your body temperature, especially when you exercise a lot or spend time doing things that make you warm. It is important for you to drink water to avoid dehydration.

The most common side effects of INVEGA HAFYERA^® include: injection site reactions, weight gain, headache, upper respiratory tract infections, feeling restlessness or difficulty sitting still, slow movements, tremors, stiffness and shuffling walk.

The most common side effects of INVEGA TRINZA^® include: injection site reactions, weight gain, headache, upper respiratory tract infections, feeling restlessness or difficulty sitting still, slow movements, tremors, stiffness and shuffling walk.

The most common side effects of INVEGA SUSTENNA^® include: injection site reactions; sleepiness or drowsiness; dizziness; feeling of inner restlessness or needing to be constantly moving; abnormal muscle movements, including tremor (shaking), shuffling, uncontrolled involuntary movements, and abnormal movements of your eyes.

Tell your healthcare professional if you have any side effect that bothers you or does not go away. These are not all the possible side effects of
INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®. For more information, ask your healthcare professional or pharmacist.

Call your healthcare professional for medical advice about side effects. You may report side effects of prescription drugs to the FDA at 1-800-FDA-1088.

General information about the safe and effective use of INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^®

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use INVEGA HAFYERA^®,
INVEGA TRINZA^® or INVEGA SUSTENNA^® for a condition for which it was not prescribed. You can ask your pharmacist or healthcare professional for information about INVEGA HAFYERA^®, INVEGA TRINZA^® or INVEGA SUSTENNA^® that is written for healthcare professionals.

For more information, go to www.invegahafyera.com, www.invegatrinza.comor www.invegasustenna.com or call 1-800-526-7736.

Please click to read the full Prescribing Information, including Boxed WARNING, for INVEGA HAFYERA^®, INVEGA TRINZA^® and
INVEGA SUSTENNA^® and discuss any questions you have with your healthcare professional.

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