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Living with Schizophrenia and Tardive Dyskinesia: An Expert Perspective

An illustration of a person with an open brain, where two small figures use ladders and tools to explore the inside.

As part of our commitment to increase awareness of and support for key therapeutic areas, we frequently invite experts to meet our staff and partners. Doctor Ilan Melnick, a certified psychiatrist in Miami and assistant professor at Florida International University's School of Medicine, recently joined the Teva Strategy Day to share his experiences with our teams around the world, as well as invited investors and media.

In addition to treating patients with conditions that range from schizophrenia to bipolar disease, Dr Melnick is the chief medical officer of Passageways, one of the largest community-controlled programs in the US. Passageways provides supervised treatment for severe and persistent chronically mentally ill patients who are involved in the criminal justice system. The program transitions patients from forensic psychiatric facilities into the community by teaching life and coping skills.

What is schizophrenia?

Schizophrenia is a mental disorder that affects how a person acts, thinks, and feels, disrupting lives with symptoms like hallucinations, delusions, and cognitive impairment. It can prevent patients from seeing the world as other people do, which means they may not want to take medication for their condition. It is often accompanied by significant stigma that can further isolate those affected, presenting challenges for patients, their families and communities.

Dr Melnick explains the science. Gray matter deficits in the outer layer of the brain’s cerebrum have been found in schizophrenia patients, with evidence of progression over time. Studies also show brain shrinkage due to ventricular enlargement in the brain. It’s important to keep patients stable to minimize the damage long term and give best outcomes, he says.

Read more: everything you need to know about schizophrenia

What type of patients do you treat?

“There's a big misconception in forensics that these patients are chronic and have been sick for a very long time,” says Dr Melnick. “We see the best outcomes when we can stabilize these patients.”

He says that he often sees relapses in patients with schizophrenia and bipolar disorder, which means they have difficulties functioning in the world. “Because of this, a lot of them end up dropping out of school or dropping out of work. I also see a cascading effect when they stop using their medicines.”

Studies show that non-adherence – not taking prescribed medication – is a major problem in the treatment of schizophrenia. Estimated non-adherence rates in schizophrenia patients are about 50%.

How do you treat your patients?

“One of the treatments we use in my practice is long acting injectable (LAI) medicines,” says Dr Melnick. LAIs are designed to release slowly into the body over an extended period such as a week, month or several months, reducing the need for frequent dosing. Studies show that LAIs may be associated with better adherence compared with oral antipsychotics in patients with early psychosis, as they reduce the burden of daily pill taking. Some patients may also prefer therapeutic injection to oral medication.

At Passageways, the team prescribes LAIs for approximately 87% of patients, to help support them in their daily lives.

LAIs are not as widely used in the US as in Europe. Why?

The difference between the US and Europe stems from early medical training, Dr Melnick believes.

“When I trained in psychiatric medicine in the US, we were taught to use LAIs as a last resort. This was due to the LAIs that were available back then, which increased the risk of movement disorders dramatically. And this created the mindset that LAIs were a last resort option.”

He explains that this situation doesn’t exist in other practice areas, where the use of LAIs is more common, such as birth control or HIV. Now that more advanced LAI solutions are available, it is time to retrain clinicians.

“I’m pushing to find ways to engage residents in the early stages of their training, working with nurse practitioner schools, for example."

What causes tardive dyskinesia and why is early diagnosis important?

Tardive dyskinesia (TD) typically arises as a side effect of prolonged use of certain medications, particularly antipsychotics. It’s characterized by repetitive, uncontrollable body movements such as grimacing and blinking. A lot of patients don’t even realize they have this condition until somebody points it out to them, explains Dr Melnick.

“Guidelines from the American Academy of Neurology and the American Psychiatric Association say we need to start recognizing and diagnosing TD earlier. We also need to start treating it earlier. We need to change mindsets and start retraining professionals – and that’s not just the clinicians, it’s everybody in those clinics and all the people around the patients. It’s empowering staff and caregivers to recognize the TD symptoms and speak up. TD is a very under-diagnosed condition and often people don’t realize that there is treatment available.”

Find out more about tardive dyskinesia

How important is empowerment and education?

“The more patients, their caregivers and medical providers are educated about this condition, the better chance people have of getting the treatment they need,” says Dr Melnick. “My goal has always been to get people to understand the importance of early treatment and early access to medicines.”

Teva: the work continues

Early diagnosis, improved access and good adherence rates are all key in the treatment of both schizophrenia and TD. Teva’s commitment to supporting patients with neurological conditions stretches back over 30 years, when we brought our first innovative medicine to market. Today we continue to focus on developing treatments that can enhance care and improve patients’ quality of life, while meeting the needs of healthcare providers.

Find out more

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