Long-term treatment with antipsychotic drugs is currently considered the standard treatment for patients diagnosed with ‘schizophrenia.’ A new study challenges this practice, however. The results, published this month in Psychological Medicine, reveal that patients who were not taking antipsychotic drugs had significantly higher levels of functioning than medicated patients.
At times, I think that I must seem like a dog with a bone, and that I just can’t let this one particular subject—the long-term effects of psychiatric drugs—go. I wrote about this in Anatomy of an Epidemic, and since then I have given many talks and written many blogs on the topic, and more recently, I engaged in a back-and-forth of sorts with Ronald Pies and Allen Frances about this. But I do think it is important that the relevant science is known, and with that thought in mind, I decided to write a paper that, in as succinct a manner as possible, would make the “case against antipsychotics.”
Over the past twenty years, the number of prescriptions for atypical antipsychotics written to children and young adults between four and eighteen has increased precipitously, according to the results of a recent study published in the journal Medicine. Two-thirds of these antipsychotics were prescribed “off-label” for unapproved uses, many for children diagnosed with ‘ADHD.’
In the first study of its kind, researchers from Finland found the “most definitive evidence to date” that smoking during pregnancy is associated with the eventual diagnosis of schizophrenia in offspring. After controlling for other potential variables, the study, published ahead of print in The American Journal of Psychiatry, revealed a 38% increased odds of developing symptoms diagnosed as schizophrenia in young adults who were exposed to high levels of nicotine in utero.
The producers of “Healing Voices” ‐ a new social action documentary about mental health ‐ are releasing the film via community screening partners in a coordinated global event. The movie will screen in more than 130 locations across the US, Canada, UK, New Zealand, and Australia on and around April 29th as part of the movie’s “ONE NIGHT, ONE VOICE” grass roots release.
Richard Bentall and David Pilgrim offer their critique of genetic theories of schizophrenia for the Conversation. "The high heritability estimates reported in earlier quantitative genetic studies don’t rule out environmental influences, but have discouraged researchers from taking social causes seriously," they write. "But we now know that there are proven strong associations between psychosis and a range of social risk factors, such as exposure to impoverished and urban environments, migration, childhood traumas (sexual or physical abuse and bullying by peers), and recent adverse experiences in adulthood."
In an exchange published in the Journal of Clinical Epidemiology, researchers take turns highlighting major problems in the way psychiatry is currently practiced in the United States. In response to an article by Vinay Prasad calling for an insistence on randomized control trials in “evidence-based” medicine, Jose de Leon, from the Mental Health Research Center at the University of Kentucky, begins the back-and-forth by pointing out that this type of evidence has been detrimental to the field of mental health.
From the Daily Beast: "Amphetamines come with a host of negative side effects, most commonly insomnia and irregular heartbeat. But in less common cases, the drug can induce a psychosis that is nearly identical to schizophrenia—so close, in fact, that scientists use it to study the disease. Far from a new discovery, it’s something that scientists and pharmaceuticals have known about for decades."
What is schizophrenia? According to the website of the National Institute of Mental Health (NIMH), schizophrenia is a chronic, severe, incurable, and disabling brain disorder that affects about 1% of Americans today. Its cause is unknown but most experts assume it is genetic. According to E. Fuller Torrey, the founder and Executive Director of the Stanley Medical Research Institute and a high-profile schizophrenia researcher, “schizophrenia is caused by changes in the brain and … these can be measured by changes in both brain structure and brain function. … Schizophrenia is thus a disease of the brain in exactly the same sense that Parkinson’s disease, multiple sclerosis, epilepsy, and Alzheimer’s disease are diseases of the brain.” Behind this confident rhetoric lies a heated controversy.
For Slate, Eliezer Sternberg outlines research suggesting that auditory hallucinations are actually “subvocal speech” produced by the patient themselves. When a schizophrenic patient hears his own voice “the unconscious matching system incorrectly identifies a mismatch (false negative) and prevents him from consciously recognizing that it is his own speech that he’s experiencing.”
Last week, the headlines blared: “Schizophrenia breakthrough as genetic study reveals link to brain changes!” We heard that our best hope for treating “schizophrenia” is to understand it at a genetic level, and that this new breakthrough would get us really started on that mission, as it showed how a genetic variation could lead to the more intense pruning of brain connections, which is often seen in those diagnosed with schizophrenia. “For the first time, the origin of schizophrenia is no longer a complete black box,” said one (while admitting that “it’s still early days”). The acting director of the National Institute of Mental Health (NIMH) described the study as “a crucial turning point in the fight against mental illness.” But is all this hype justified?
Another scientific study that ostensibly identifies a biological cause of schizophrenia has appeared and is being widely reported. So, we finally have the elusive breakthrough to understanding the biological basis of schizophrenia. Or do we? A close look at the source of all this hyperbolic language raises serious questions about such enthusiasm.
Families are often very important for people encountering severe mental and emotional difficulties. But how can family members really know what is helpful, and what is likely to make things worse for the person having problems? Similarly, for those who want to help families, how can they know what will really be helpful for those families, and what will make things worse?
In a featured article for Psychiatric Services, psychiatrists from Dartmouth raise the alarm on the increasing numbers of children prescribed dangerous antipsychotic drugs. Despite the fact that data on the safety of long-term use of these drugs in this vulnerable population “do not exist,” the rate of children and adolescents being prescribed antipsychotic drugs have continued to increase over the past fifteen years.
Readers respond to the New York Times article, “The Treatment of Choice,” about innovative programs for psychosis and schizophrenia that involve patients and their families in treatment decisions. “Narratives of success counter a drumbeat of faulty links of mental illness and violence, inaccuracies which serve only to further stigmatize and isolate individuals with psychiatric illness.”
The German news agency DW features a video report on whether cannabidiol, an active substance derived from marijuana, can help relieve the symptoms of schizophrenia.
I was a psychiatrist who participated in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). Although I welcomed the positive headlines that heralded the study’s results, the reports left me with mixed feelings. What happened to render the notion that talking to people about their experiences and helping them find jobs or go back to school is something novel?
Many people are now familiar with the BPS report, Understanding Psychosis and Schizophrenia, and they have appreciated how it integrates both science and a humanistic understanding to convey a fresh and progressive approach to difficult and extreme experiences. But it has come under attack by psychiatrists, using arguments that are often quite slick, and sound reasonable to the uninformed. But they are wrong, and the better we can articulate how and why they are wrong, the better we can advocate for a more humane and skillful response to people having the experiences that are called “psychosis.”
Writing on his 1 Boring Old Man blog, Dr. Mickey Nardo reflects on the media frenzy around the RAISE study and asks why the prescription data has not been released. He adds skepticism about the political motives of the potentially overblown results, which he sees as a clear push for increased mental health funding.
Results of a large government-funded study call into question current drug-only approaches to treating people diagnosed with schizophrenia. The study, which the New York Times called “by far the most rigorous trial to date conducted in the United States,” found that patients who received increased drug counseling along with individual talk therapy, family training, and support for employment and education experienced a greater reduction in symptoms, were more likely to resume work and school, and reported a higher quality of life than those receiving current standard treatments.
For the past four years, I have been deconstructing my views of my profession. My focus has been primarily in two areas: the efficacy and safety of the drugs I prescribe and the so-called “alternative” approaches (in this I include many things such as Open Dialogue, Hearing Voices groups, and Intentional Peer Support to name a few). I have shared much of this in the blogs I wrote during this time. I am also interested in how we can improve and reform the public mental health system since this is not only where I work but where most people seek services and help. I wonder where – if anywhere – psychiatrists fit in to a reformed system.
That was the emphatic response from my grad school psychopathology professor 35 years ago, after I’d stated in her class that anyone could become psychotic given sufficient life stressors, losses and trauma. How many current mental health professionals, especially psychiatrists, also believe they have such strong egos that they never could experience extreme states?
New data on the effects of social support after the onset of psychosis suggests that patients with intense social support function better than those without such help, but than once supports are removed the effects eventually diminish.
“When people with early-stage symptoms took omega-3 supplements for three months, they had much lower rates of progression than those who did not,” according to research out of Australia covered in this month’s issue of the New Scientist. More →
Cognitive behavioral therapy or CBT has been pretty heavily criticized by a number of Mad in America (MIA) bloggers and commenters in the past few years. In a way that isn’t surprising, because most MIA bloggers are looking for radical change, and CBT often appears to be part of the establishment, especially within the therapy world. But while I’m all for criticizing what’s wrong with CBT, especially with bad CBT, I think there’s also a danger in getting so caught up in pointing out real or imagined flaws that we fail to notice where CBT can be part of the solution, helping us move toward more humanistic and effective methods of helping.
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