“Recovery, Not Progressive Illness, Should Be the Expectation in Schizophrenia”

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In World Psychiatry, two Canadian psychiatrists argue that the body of scientific evidence about schizophrenia shows that it is not a progressive illness and therefore we should have much higher expectations of full recoveries than we do.

“Despite the introduction of effective pharmacological treatments and evidence-based psychosocial interventions, fewer than one in seven people affected are considered to meet criteria for recovery,” the authors write. “The possibility that the pathophysiology of schizophrenia involves mechanisms that progress over the longitudinal course of the illness is often assumed to explain the poor outcomes observed. Advocates for early intervention have embraced this paradigm… While progression of an active disease process would provide a compelling explanation for the poor outcomes so commonly observed, it is not consistent with what we have learned from modern studies of the longitudinal course of structural brain abnormalities, cognitive deficits and clinical outcomes associated with schizophrenia.”

Zipursky, Robert B., and Ofer Agid. “Recovery, Not Progressive Deterioration, Should Be the Expectation in Schizophrenia.” World Psychiatry 14, no. 1 (February 1, 2015): 94–96. doi:10.1002/wps.20194. (Full text)

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18 COMMENTS

  1. Interesting excerpt from the article!

    Upon reading the full article, I stumbled upon one of its references (#21 “Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review”), in which there is a strong bias towards continued medication in patients with schizophrenia. To quote from the abstract of this second article:

    “Six studies were identified that met our criteria and these reported a weighted mean one-year recurrence rate of 77% following discontinuation of antipsychotic medication. By two years, the risk of recurrence had increased to over 90%. By comparison, we estimated the one-year recurrence rate for patients who continued antipsychotic medication to be 3%. These findings suggest that in the absence of uncertainty about the diagnosis or concerns about the contribution of medication side effects to problems with health or functioning, a trial off of antipsychotic medications is associated with a very high risk of symptom recurrence and should thus not be recommended.”

    This stance is echoed in the primary article in this news item:

    “While we may be inclined to try to eventually discontinue
    antipsychotic medication for those patients who have the
    best response and remission, this may be misguided. It should
    not be surprising that those patients who respond most
    robustly to dopamine D2 antagonists may also be most likely
    to become ill when those same medications are discontinued.
    With antipsychotic medication, the large majority of individuals
    with a first episode of schizophrenia are able to achieve
    and sustain symptomatic remission. Without medication, few
    if any patients with a diagnosis of schizophrenia are likely to
    remain in remission.”

    Firstly it strikes me that these conclusions does not jibe very well with the overall findings on functional recovery and longterm maintenance treatment (Harrow etc…). And secondly I have difficulty reconciling the articles statement that schizophrenia is probably not a progressive neurodegenerative disorder and the same articles warning about trying to discontinue antipsychotic medication. Unless of course it is the authors point of view, that schizophrenia first and foremost is a stable and chronic brain disease.

    It is also a bit surprising that the article is so adamant about excluding the possibility of getting well and staying well without medication.

    Well, that was sort of a reflection on the article – it would be interesting to read other reflections… or reflections on the reflection 🙂

    Best
    Jonathan

  2. I’m quite certain the psychiatric and medical communities should take another look at the actual effects of what they call “effective pharmacological treatments.” We know the psychiatric “gold standard” of “effective pharmacological treatments” for schizophrenia are neuroleptics. But here’s what drugs.com warns about too high a dose, or use of more than one neuroleptic, which is “standard of care” in today’s psychiatric system:

    “Agents with anticholinergic properties (e.g., … neuroleptics; …) may have additive effects when used in combination. Excessive parasympatholytic effects may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures …”

    The symptoms of “the anticholinergic intoxication syndrome” are almost identical to the symptoms of schizophrenia (the only difference being whether the patient is “inactive” or “hyperactive” – but, of course, all doctors should know these major tranquilizers make all people very tired). But this means it’s possible, or even likely, that the most common cause of schizophrenia (and bipolar) in our society today is doctors misdiagnosing the central symptoms of neuroleptic induced anticholinergic intoxication as schizophrenia (or bipolar).

    Wouldn’t it be great if we could cure the world of most of the bipolar and schizophrenia, merely by making doctors aware of the fact that the neuroleptic drugs can and do cause the serious symptoms of these “lacking in validity” disorders?

      • Perhaps, since “Risperidone is a second-generation atypical antipsychotic.[2] It is a dopamine antagonist possessing anti-serotonergic, anti-adrenergic and anti-histaminergic properties,” it alone can cause the symptoms of anticholinergic intoxication syndrome, that is theorized to only be caused by use of multiple drugs?

    • “I’m quite certain the psychiatric and medical communities should take another look at the actual effects of what they call “effective pharmacological treatments.”

      I think you’re quite right about the importance of being clear on the actual effects. In the referenced article (note #21, by the same first author) the phrasing: “in the absence of uncertainty about the diagnosis or concerns about the contribution of medication side effects to problems with health or functioning, a trial off of antipsychotic medications is associated with a very high risk of symptom recurrence and should thus not be recommended,” is a way of sidestepping two huge issues – because in real life there ARE issues of side effects and health as well as concerns about the validity of the diagnosis-construct.

      • Absolutely, and as I pointed out below, it’s possible that the most common actual etiology of schizophrenia is psychiatrists misdiagnosing concerns or symptoms of child abuse as psychosis, thus either bipolar or schizophrenia. And of course, concerns or symptoms of child abuse are not actually brain diseases cured with neuroleptics, and other psychiatric maltreatment.

        It took my quoting my oral surgeon, “concerns of child abuse are not cured with antipsychotics,” for an inane “top doc” psychiatrist to finally become embarrassed enough to wean me off these horrendous drugs. And since the neuroleptics can cause the schizophrenia symptoms, in my case at merely a child’s dose, I don’t think they should be given to the 77% of child abuse victims who are having symptoms of this type crime misdiagnosed as psychosis.

        And in as much as it is true being weaned off the antipsychotics does result in drug withdrawal induced super sensitivity manic psychosis, one does recover from this withdrawal syndrome. All those who had concerns or symptoms of child abuse misdiagnosed as psychosis would be much better off getting psychological help, justice, and love, rather than having the symptoms of schizophrenia created for their entire life via the central symptoms of neuroleptic induced anticholinergic intoxication syndrome.

      • “in the absence of uncertainty about the diagnosis or concerns about the contribution of medication side effects to problems with health or functioning, a trial off of antipsychotic medications is associated with a very high risk of symptom recurrence and should thus not be recommended,”

        Let’s translate this, if the doctor is certain the patient has schizophrenia (which none logically can be, since schizophrenia is not known to be a valid disease). Or the doctor has concerns that the known neuroleptic side effects are contributing to the health problems or functioning (in other words, if the doctor realizes he has committed iatrogenesis / malpractice). Then “a trial off of antipsychotic medications is associated with a very high risk of symptom recurrence and should thus not be recommended,” or in other words, taking patients who react poorly to the neuroleptics off them is not recommended.

        This is medical advise to prevent a malpractice suit, but not medical advice as to how to help patients, since those patients who are allergic to the neuroleptics are better off them. And patients that are made worse with the antipsychotics can heal from drug withdrawal induced super sensitivity manic psychosis, but they will never heal if they are kept on drugs that make them sick.

        Pretty sick advice, from a patient perspective.

        • You’re 100 per cent right Someone Else,
          my medical record reflects this.

          I cannot understand why the average doctor cannot recognise that good solutions exist outside of tranquillization.

          The withdrawal syndrome is with me till today, 30 years later – but to be truthful I can cope with it.

  3. If those who treat the mentally ill would listen to them rather than to those who seek to profit off of their distress, they would have a better grip of the reality of the situation. Treatment with neuroleptics is a devastating and debilitating illness with symptoms of physical and mental illness. As long as a person is treated this way they will not recover. Physicians who prescribe the potent drugs should be required to try them themselves before being able to dispense them…much like police officers being required to be tased before being issued a taser.

    • Here’s what John Read, Phd points out about this subject:

      “Of 100 child inpatients, 77 percent of those who had been sexually abused received a diagnosis of a psychosis, compared with 10 percent of those who had not been abused (11). Compared with other psychiatric patients, patients who had been abused as children have earlier first admissions, have longer and more frequent hospitalizations, spend more time in seclusion, are more likely to receive psychotropic medication, relapse more frequently, and are more likely to attempt suicide (1,12). In one sample composed predominantly of female outpatients with schizophrenia or schizoaffective disorder, 92 percent had suffered childhood sexual or physical abuse (13).”

      Wow, if a patient expresses concerns or has symptoms of child abuse they have a 77% chance of being diagnosed with psychosis, thus bipolar or schizophrenia. But these are supposedly brain diseases … and concerns or symptoms of child abuse aren’t brain diseases.

      And if 92% of schizophrenics have “suffered childhood sexual or physical abuse” it appears that the most common cause of schizophrenia very well may be psychiatrists misdiagnosing the symptoms of child abuse as psychosis.

      I personally would be among the 8% who did not suffer childhood sexual or physical abuse, because I only had concerns of the sexual abuse of my child misdiagnosed as psychosis (and the therapist who did this even handed over her medical records with proof she misdiagnosed me based on lies from the alleged child molesters). And some decent nurses in my PCPs office eventually handed over the medical evidence of the child abuse, documented in my child’s medical records.

      But for some reason the police aren’t arresting the child molesters any longer in the USA. Now the police tell moms with medical evidence of child abuse that the regular people have to make sacrifices, and allow the wealthy and / or clergy to sexually molest their three year old children.

      I believe the psychiatric industry should stop covering up child abuse by misdiagnosing concerns and symptoms of child abuse as psychosis, and creating the schizophrenia symptoms via the central symptoms of neuroleptic induced anticholinergic intoxication syndrome. I think it’s be better if we started to prosecute the child molesters instead.

      It does appear that psychiatric misdiagnoses of the sexual abuse of children as “psychosis,” and the subsequent drugging of the victims of child abuse with neuroleptics, is the most likely cause of schizophrenia in the USA today.

  4. The whole part of the article called Structural Brain Findings in Schizophrenia contradicts itself. And the language is truly misleading, and tries to lead people into making conclusions that aren’t there.
    ” Increases in cerebrospinal fluid (CSF) volumes, together with deficits in both gray matter and white matter volumes, have been reported in patients with chronic schizophrenia and are present to a lesser degree in individuals studied at the time of their first episode of psychosis”

    and

    “The increases observed in the magnitude of structural brain findings over the course of schizophrenia may be better explained by medication effects, together with differences in exposure to alcohol, drugs of abuse, smoking and levels of activity”

    One can only wonder what “lesser” means, this could also mean there’s no real correlation unless they tweet the findings. “Lesser” says nothing. And then, when there’s clear evidence completely what neuroleptics do to the brain, they use the words “may be” because this would otherwise over ride their ideology. When they thought that too much grey matter had something to do with ADHD, and upon giving children with what they thought was too much grey matter ADHD medications and this didn’t increase growth of white cells, it was widely reported (and evidently believed) that giving them ADHD medications at an earlier stage would help white cells grow. And this is the industry talking about cognitive problems.

    One can only wonder how many people that truly have recovered they don’t care to find out about. And why they have the bleak results they report, with those who try to get off of the medications (clearly with NO help, no informed consent, coercion to take the medications, intimidation that they need them, all extremely frustrating for someone who can feel how the medications dull their emotions and responses) and thus the results. I’m sure they didn’t give the people who were trying to get off of the medications the choice to go to places where there was understanding of how to get off of the medications (which trying to get off of in themselves can cause psychosis) or the choice to go to those who can work with first time psychosis and achieve the results that Open Dialogue, Healing Homes of Finland and Soteria Project does, without coercion to take medications.

    I have to add that being around this kind of environment (and “community”) clearly doesn’t promote recovery, they list their own bleak results. Other methods do have recovery.

  5. I am a schizophrenia sufferer with over 15 years of experience with the illness. I know that recovery is possible, and as I am nearly recovered. I can’t function without medication. I have tried. I therefore know that it has a major role in my recovery. To confirm widespread suspicion about abuse and psychosis, I was mentally abused as a child. However many people from my father’s side have mental illnesses and were never abused. I want to concur that schizophrenia is not a largely progressive illness. It is in fact just like type 2 diabetes because it affects a person physiologically and psychologically, and it starts later on in life. Plus you can recover from it, and medication works really well. And if you treat it well it gets better, and if you don’t it gets worse. There are certain prerequisite patterns to recovery though, and I fit every one.

    My father was a doctor, my mother a mental health nurse, my sister lectures on schizophrenia, and my brother has a masters in neuropsychology. Therefore my medical family had given everything.

    My father as a pattern for recovery died before my diagnosis, and I have insight into my illness. And I exercise, eat healthily, don’t drink much, don’t use drugs, and I have a wife. But I am not alone, I am friends with people who are doing as well as I am with the illness. I know of doctors with the illness. But they hide it, because of stigma. Research is biased to think schizophrenia is progressive, and those who agree with that conclusion are ignorant of the people behind the illness. They suffer with intellectualism and they cannot think for themselves which is why they ignore the hidden evidence of significant recovery from the schizophrenia as indicated by the man who coined the word schizophrenia himself. He never confused it with split mind as did one person on this. comment thread. Please do not use the word “schizophrenic” in a prejoritive manner.

    I see the illness for what it is: a long term episode that rights with decades of proper treatment. It is the worst mental illness known to man, but it is very treatable with good prognosis especially for paranoid sufferers.

    Those who commit suicide often abuse drugs, those who never progress never educate themselves. People who commit crimes are criminals, those who never find the root cause of their delusion stay deluded. People who listen to quacks are lost, and those who have no education have little progressive guidance or proper support. The rest however like myself do recover or get close to recovery. Let’s please end the myth, that this illness is a mysterious plague on mankind. That is Hollywood nonsense.

    Schizophrenia is not what idiots make it out to be. Ironically (many psychiatrists) they project their delusions about religion, psychiatry, politics, outdated ideological beliefs onto people who could not disagree more with their conclusions about an illness they do not have or ever could understand.

  6. Na na na na na na

    Its simple. In almost all cases, schizophrenia just gets worse over time and gets WAY worse if you EVER take medication.

    Second, the psyciatric proffession wants you to think it will get better over time! They want you to suffer! This is a classic evil trick/brainwashing. They want you to think you are okay while you are suffering horribly, because some people out there do benefit from your suffering.

    I believe recovery is possible, to a lrge degree, however. Most people do not know how to do it. Check out my website howtotreatschizophrenia.wordpress.com
    and drlwilson.com as well