Approaching Schizophrenia Care: Lessons from a Care Partner Turned Nurse

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Sponsored by Bristol Myers Squibb

 

Fines Shaw, PMHNP was paid honoraria by Bristol Myers Squibb.

For many nurses and nurse practitioners, our profession begins in a classroom or clinical setting. For me, it began at home.  When my mother was 31, she was diagnosed with schizophrenia. Looking back, the time I spent as her care partner was formative for me, and the skills I learned through that experience became even more important when my daughter was diagnosed with schizophrenia.

Through my experiences as a care partner for both my mother and my daughter, I came to understand how misunderstood schizophrenia is.  The condition affects far more than the person diagnosed. It touches every aspect of daily life for families and loved ones as well.[i] Those experiences shaped me as a nurse and reinforced how important it is to listen and advocate for patients, and work alongside them to find the most appropriate care and treatment options.

My personal connection to schizophrenia didn’t just change my understanding of the condition – it changed my life. Prior to my daughter’s diagnosis, I had been working as an emergency room nurse. Once we learned her condition though, I knew I wanted to focus my efforts in the mental health space. Ultimately, I became a psychiatric and mental health nurse practitioner, which allowed me to advocate for others experiencing challenges, especially with schizophrenia. It also taught me empathy, gave me better insight into the needs of my patients and made me want to share my story in the hopes it helps other healthcare professionals in their practice.

Life as a Care Partner

From the time I was a child, I saw firsthand how schizophrenia could impact someone’s life, often bringing periods of instability and uncertainty. Over time though, I became more resilient and developed ways to better support someone living with schizophrenia – something that would prepare me, in unexpected ways, for motherhood.

When my daughter was in her teenage years, I noticed she was starting to isolate more. She eventually confided in me that she was experiencing a number of symptoms that were affecting her daily life. Although at times the uncertainty was overwhelming, I applied what I had learned through my mother’s experience and as a nurse to help my daughter find answers. It took time, and many healthcare professionals, before she received her diagnosis. It came with a mix of complex emotions, but we felt a sense of relief in having clarity. What grounded me throughout the process though was my commitment to be present: to listen, to learn, and to create a safe space where she could share her experiences without judgement.

I’m reminded that support and compassion are essential. Staying by someone’s side becomes a way of supporting and guiding them toward care, but it also can reaffirm one’s purpose.

My Past Shaping My Future

Searching for answers as a care partner was frustrating at times and often left me feeling helpless, but that uncertainty became a catalyst. When advocating for my daughter, I wanted to ensure that others facing similar challenges felt seen, heard, and supported.

Now as a mental health professional, I often reflect on my experiences and channel the concerns and challenges I faced as a care partner to inform every aspect of my practice. By remembering my own hesitation to ask questions and my unspoken fears, I’m able to understand what my patients may be experiencing under the surface and really use that to build trust and have open, honest conversations.

Between my formal training and personal connection to schizophrenia, I can recognize symptoms more quickly, communicate with greater empathy, and appreciate the importance of finding the right treatment for each individual to meet their unique needs.

COBENFY as a Treatment Option

My personal experiences helped me realize how critical nurses and nurse practitioners are in guiding patients with schizophrenia through their treatment journeys and gave me a deeper understanding of the responsibility we have in really listening and exploring different approaches based on their overall symptoms. For several of my adult patients living with schizophrenia, one of those approaches has been COBENFY™ (xanomeline and trospium chloride), a twice-daily oral medication for adults with schizophrenia.[ii]

It is not known if COBENFY is safe and effective in children. Please see Important Safety Information below and  U.S. Full Prescribing Information and Patient Information for COBENFY.

COBENFY is a unique combination of a xanomeline, a dual M1– and M4-preferring muscarinic receptor agonist, and trospium chloride, a muscarinic antagonist. Xanomeline binds to muscarinic receptors M1 to M5 with comparable affinity and exhibits higher agonist activity at the M1 and M4 receptors. Trospium chloride antagonizes the muscarinic receptors primarily in the peripheral tissues. Unlike other schizophrenia treatments, COBENFY does not bind to dopamine D2 receptors. While the exact mechanism of action of COBENFY is unclear, selective M1 and M4 receptor activation is believed to modulate dopamine release. [iii]

The safety and tolerability profile of COBENFY has been demonstrated in over 1,250 patients across five clinical trials, including the short-term 5-week EMERGENT-1, EMERGENT-2 and EMERGENT-3 trials, and the long-term open-label 52-week EMERGENT-4 and EMERGENT-5 trials. The most common adverse reactions (≥ 5 % and at least twice placebo) in the short-term trials were nausea, dyspepsia, constipation, vomiting, hypertension, abdominal pain, diarrhea, tachycardia, dizziness, and gastroesophageal reflux disease (GERD). Additional adverse reactions include dry mouth, somnolence, blurred vision, salivary hypersecretion, orthostatic hypotension, cough and extrapyramidal symptoms (non-akathisia).

COBENFY has warnings and precautions for: risk of urinary retention, risk of use in patients with hepatic impairment, risk of use in patients with biliary disease, decreased gastrointestinal mobility, risk of angioedema, risk of use in patients with narrow-angle glaucoma, increases in heart rate, anticholinergic adverse reactions in patients with renal impairment, and central nervous system effects.

Please see Full Important Safety Information and U.S. Full Prescribing Information, including contraindications, below.

Where Lived Experience Meets Care

For me, bridging my lived experience with clinical practice is not just part of my profession; it’s the responsibility I carry into every patient interaction.

As both a nurse and a care partner, it’s important to me to share what I’ve learned about schizophrenia to help other healthcare professionals better connect with their patients and consider what they may be experiencing. It’s only then that we can truly understand their needs and help connect patients with the treatment option that is right for them. For appropriate patients, that treatment may be COBENFY.

Read more here about the importance of listening and connecting with your patients, and visit COBENFYHCP.com to learn more about COBENFY, including additional findings from the trials and resources to determine if COBENFY could be right for your patients.

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INDICATION 

COBENFY™ (xanomeline and trospium chloride) is indicated for the treatment of schizophrenia in adults.

IMPORTANT SAFETY INFORMATION 

CONTRAINDICATIONS
COBENFY is contraindicated in patients with:

  • urinary retention
  • moderate (Child-Pugh Class B) or severe (Child-Pugh Class C) hepatic impairment
  • gastric retention
  • history of hypersensitivity to COBENFY or trospium chloride. Angioedema has been reported with COBENFY and trospium chloride.
  • untreated narrow-angle glaucoma

WARNINGS AND PRECAUTIONS 

Risk of Urinary Retention: COBENFY can cause urinary retention. Geriatric patients and patients with clinically significant bladder outlet obstruction and incomplete bladder emptying (e.g., patients with benign prostatic hyperplasia (BPH), diabetic cystopathy) may be at increased risk of urinary retention.

COBENFY is contraindicated in patients with pre-existing urinary retention and is not recommended in patients with moderate or severe renal impairment.

In patients taking COBENFY, monitor for symptoms of urinary retention, including urinary hesitancy, weak stream, incomplete bladder emptying, and dysuria. Instruct patients to be aware of the risk and promptly report symptoms of urinary retention to their healthcare provider. Urinary retention is a known risk factor for urinary tract infections. In patients with symptoms of urinary retention, consider reducing the dose of COBENFY, discontinuing COBENFY, or referring patients for urologic evaluation as clinically indicated.

Risk of Use in Patients with Hepatic Impairment: Patients with hepatic impairment have higher systemic exposures of xanomeline, a component of COBENFY, compared to patients with normal hepatic function, which may result in increased incidence of COBENFY-related adverse reactions.

COBENFY is contraindicated in patients with moderate or severe hepatic impairment. COBENFY is not recommended in patients with mild hepatic impairment.

Assess liver enzymes prior to initiating COBENFY and as clinically indicated during treatment.

Risk of Use in Patients with Biliary Disease: In clinical studies with COBENFY, transient increases in liver enzymes with rapid decline occurred, consistent with transient biliary obstruction due to biliary contraction and possible gallstone passage.  

COBENFY is not recommended for patients with active biliary disease such as symptomatic gallstones. Assess liver enzymes and bilirubin prior to initiating COBENFY and as clinically indicated during treatment. The occurrence of symptoms such as dyspepsia, nausea, vomiting, or upper abdominal pain should prompt assessment for gallbladder disorders, biliary disorders, and pancreatitis, as clinically indicated.

Discontinue COBENFY in the presence of signs or symptoms of substantial liver injury such as jaundice, pruritus, or alanine aminotransferase levels more than five times the upper limit of normal or five times baseline values.

Decreased Gastrointestinal Motility: COBENFY contains trospium chloride. Trospium chloride, like other antimuscarinic agents, may decrease gastrointestinal motility. Administer COBENFY with caution in patients with gastrointestinal obstructive disorders because of the risk of gastric retention. Use COBENFY with caution in patients with conditions such as ulcerative colitis, intestinal atony, and myasthenia gravis.

Risk of Angioedema: Angioedema of the face, lips, tongue, and/or larynx has been reported with COBENFY and trospium chloride, a component of COBENFY. In one case, angioedema occurred after the first dose of trospium chloride. Angioedema associated with upper airway swelling may be life-threatening. If involvement of the tongue, hypopharynx, or larynx occurs, discontinue COBENFY and initiate appropriate therapy and/or measures necessary to ensure a patent airway. COBENFY is contraindicated in patients with a history of hypersensitivity to trospium chloride.

Risk of Use in Patients with Narrow-angle Glaucoma: Pupillary dilation may occur due to the anticholinergic effects of COBENFY. This may trigger an acute angle closure attack in patients with anatomically narrow angles. In patients known to have anatomically narrow angles, COBENFY should only be used if the potential benefits outweigh the risks and with careful monitoring. 

Increases in Heart Rate: COBENFY can increase heart rate. Assess heart rate at baseline and as clinically indicated during treatment with COBENFY.

Anticholinergic Adverse Reactions in Patients with Renal Impairment: Trospium chloride, a component of COBENFY, is substantially excreted by the kidney. COBENFY is not recommended in patients with moderate or severe renal impairment (estimated glomerular filtration rate (eGFR) <60 mL/min). Systemic exposure of trospium chloride is higher in patients with moderate and severe renal impairment. Therefore, anticholinergic adverse reactions (including dry mouth, constipation, dyspepsia, urinary tract infection, and urinary retention) are expected to be greater in patients with moderate and severe renal impairment.

Central Nervous System Effects: Trospium chloride, a component of COBENFY, is associated with anticholinergic central nervous system (CNS) effects. A variety of CNS anticholinergic effects have been reported with trospium chloride, including dizziness, confusion, hallucinations, and somnolence. Monitor patients for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. Advise patients not to drive or operate heavy machinery until they know how COBENFY affects them. If a patient experiences anticholinergic CNS effects, consider dose reduction or drug discontinuation.

Most Common Adverse Reactions (≥5% and at least twice placebo): nausea, dyspepsia, constipation, vomiting, hypertension, abdominal pain, diarrhea, tachycardia, dizziness, and gastroesophageal reflux disease. 

Use in Specific Populations:  

  • Moderate or Severe Renal Impairment: Not recommended
  • Mild Hepatic Impairment: Not recommended

Pregnancy and Lactation: There is a pregnancy exposure registry that monitors outcomes in women exposed to psychiatric medications, including COBENFY, during pregnancy. Healthcare providers are encouraged to advise patients to register by calling 1-866-961-2388 or visiting https://womensmentalhealth.org/research/pregnancyregistry/atypicalantipsychotic/.

There are no available data on COBENFY use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Additionally, there are no data on the presence of xanomeline or trospium in human milk, the effects on the breastfed infant, or the effects on milk production. However, xanomeline and trospium are present in animal milk, suggesting they may also be present in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for COBENFY and any potential adverse effects on the breastfed infant from COBENFY or the underlying maternal condition.

COBENFY (xanomeline and trospium chloride) is available in 50mg/20mg, 100mg/20mg, and 125mg/30mg capsules.

Please see U.S. Full Prescribing Information, including Patient Information. 

Cobenfy and the Cobenfy logo are trademarks of Karuna Therapeutics, Inc., a Bristol Myers Squibb company.

© 2026 Bristol-Myers Squibb Company.

1629-US-2600203  07/26

[i] Valery KM, Prouteau, A. Schizophrenia stigma in mental health professionals and associated factors: a systematic review. Psychiatry Research. 2020;290:113068.

[ii] COBENFY. Prescribing Information. Bristol-Myers Squibb Company; 2026.

[iii] Dean B, Bakker G, Ueda HR, Tobin AB, Brown A, Kanaan RAA. A growing understanding of the role of muscarinic receptors in the molecular pathology and treatment of schizophrenia. Front Cell Neurosci. 2023;17:1124333.

 

Fines Shaw, DNP, PMHNP
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