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Helping people with schizophrenia

Friday 08 January 2021

For people who have schizophrenia, daily life can be tough as they battle with their condition; throw a cancer diagnosis into that situation and life becomes all the more harder.

In fact, people with schizophrenia are dying 16 years younger than the general population, primarily due to cancer and other serious illnesses.

Professor Dan Siskind, a clinical academic psychiatrist at the Princess Alexandra Hospital (PAH) is hoping to change that.

Currently, Prof Siskind's research work has two major focuses aimed at improving physical and mental health outcomes for people who have schizophrenia; investigating ways to reduce the side effects of schizophrenia medication clozapine, and exploring the reasons why people with schizophrenia and cancer have poorer outcomes than people without schizophrenia.

Prof Dan Siskind

"My area of interest is people with schizophrenia, particularly what we call treatment-refractory schizophrenia. This is a form of schizophrenia that doesn't get better with first line treatments. There is a medication that we commonly use called clozapine. It is far and away our most effective anti-psychotic but is associated with a lot of side effects," he said.

"I do a lot of work on managing those side effects. We look at how to reduce the risks of side effects such as low white blood cells, obesity diabetes, constipation, and cardiac side effects. We need to make this this medication safer for people to use because there is no other antipsychotic as effective as clozapine."

Among his current research projects are Metro South Health funded trials of the effectiveness of a diabetes medication to help improve the physical health of people with schizophrenia, and in turn, give them better outcomes for both their physical and mental health.

With pilot studies already completed, and working in partnership with PAH colleagues in the endocrinology department, Prof Siskind has some funding for larger trials in the near future.

"The antipsychotic drug clozapine and other antipsychotics interfere with a particular peptide signalling process in the gut. When people on clozapine have a meal they don't realise they are full. They keep pumping sugar into the blood from their liver, and their cells don't get ready to use the sugar. This leads to spikes in blood sugar levels, which is then turned into fat. This increases people's risk of diabetes," Prof Siskind said.

"There is a class of diabetes medications, 'glucagon-like peptide receptor agonists', that replaces the missing peptide. I'm interested in using this diabetes drug to help normalise blood sugar for people who are on these antipsychotic medications.

"This medication class, was previously only available as an injection. They have just come out in tablet form. We are exploring using the tablet version to try and normalize people's blood sugars and help reduce weight gain."

Of interest to people with cancer and their families is a study Prof Siskind is conducting in collaboration with PAH based UQ Professor of Psychiatry, Professor Steve Kisely. This study aims to explore barriers to quality cancer care for people with cancer and schizophrenia.

"We know that people with schizophrenia have similar rates of most cancers as the general population. However they are much more likely to die. We are doing a large study to look at where do things fall down," Siskind said.

"We are looking at bowel cancer among people with schizophrenia. We are examining rates of bowel cancer screening among people with schizophrenia. Particularly, we are comparing people with schizophrenia and the general population on: did they return the screening kit, did it test positive or negative, if it tested positive did someone follow up with them, if they got followed up did they get a colonoscopy, and if the colonoscopy found bowel cancer, did they get an evidence based treatment."

"We're trying to work out where things fall down in the treatment pathway. If we know where the barriers are, we can address them.

"We are interested examining other forms of cancer. Currently we are looking at bowel cancer, but we the next step would be melanoma, particularly here in Queensland."

Having worked overseas and for organisations like Doctors Without Borders and spending the last 12 years working at the PAH, Prof Siskind believes supporting medical research is a worthy endeavour for anyone who is looking to donate, big or small.

"The PA Foundation supports research like mine which saves lives of underserved populations. People with schizophrenia aren't very good at advocating for themselves. They often don't have a lot of family support. It's really important for the Foundation to be an advocate for the physical needs of underserved and marginalised populations," he said.

"Because if the Foundation doesn't do it, no one is going to."