Negative Schizophrenia Symptoms Reduce Over Time — With or Without Treatment

Rob Wipond
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The strength of “negative” symptoms of schizophrenia such as blunted speech, social withdrawal and inability to experience pleasure tends to reduce over time both with and without treatment, according to a study in Psychological Medicine.

Psychiatric researchers from the World Health Organization collaborating Centre for Mental Health Service Development at Queen Mary University in the UK conducted a meta-analysis of 41 studies with 5,944 participants. “Negative symptoms were found to significantly reduce in all treatment interventions, including in placebo and treatment as usual conditions,” they wrote.

“This finding offers a further critique of the historical argument which suggests schizophrenia is a disorder of continual decline and instead provides further support to the recovery model of schizophrenia,” they concluded. “Overall, these findings suggest that negative symptoms may not be as resistant to change as what has previously been assumed, and perhaps offer new hope to those who may experience such symptoms.”

Savill, M., C. Banks, H. Khanom, and S. Priebe. “Do Negative Symptoms of Schizophrenia Change over Time? A Meta-Analysis of Longitudinal Data.” Psychological Medicine 45, no. 08 (June 2015): 1613–27. doi:10.1017/S0033291714002712. (Abstract)

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Rob Wipond
Rob Wipond is a Victoria, British Columbia-based freelance journalist who has been writing on mental health issues for fifteen years. His research has particularly focused on the interfaces between psychiatry, the justice system, and civil rights. His articles have been nominated for three Canadian National Magazine Awards, six Western Magazine Awards, and four Jack Webster Awards for journalism. He can be contacted through his website.

8 COMMENTS

  1. I hope the psychiatric community some day learns that the “gold standard” treatment for schizophrenia, the neuroleptics, can indeed cause both the negative and positive symptoms of schizophrenia:

    “Neuroleptic induced deficit syndrome is principally characterized by the same symptoms that constitute the negative symptoms of schizophrenia—emotional blunting, apathy, hypobulia, difficulty in thinking, difficulty or total inability in concentrating, attention deficits, and desocialization. This can easily lead to misdiagnosis and mistreatment. Instead of decreasing the antipsychotic, the doctor may increase their dose to try to ‘improve’ what he perceives to be negative symptoms of schizophrenia, rather than antipsychotic side effects.”

    And when people who suffer an adverse reaction to a neuroleptic are misdiagnosed and mistreated, most often as noted above, by increasing the dose of the antipsychotic or adding another antipsychotic. The negative symptoms of schizophrenia may disappear, but the positive symptoms of schizophrenia will likely materialize via the central symptoms of neuroleptic induced anticholinergic intoxication syndrome:

    “neuroleptics … 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 adverse drug effects of the “gold standard” treatment for schizophrenia, and medical misdiagnoses of these as schizophrenia or bipolar, are a likely primary cause of the major mental illnesses.

  2. S. E. – Doctors also act in order to appear familiar with what they believe is expected of them. I hope Drs. Moncrieff, Steingard, and Jeremy Wallace, maybe evetually Jospeh Tarantolo get around to elaborating on the further points that your commentary indicates for what the doctors assume and claim to believe. These first three tend to discuss lots of examples of their fellows missing the point of their data sets and patient records, and acting wrongheaded in prescribing, and not questioning enough theoretically. But I hope they start getting around more to just how bad the average psychiatrist is at their job. If the psychiatrists I had seen running hospital wards and doing med checks had been sensible and willing to think for themselves, even without going into the myth of mental illness to straighten their staff’s attitudes out, they could have kept Robert Whitaker from having this job as the voice of psych reform. That is also why I think he should try to get that idea straight and talk about it. Szasz wasn’t someone who left the brain out of consideration, he thought that medicine doesn’t kick in except to isolate and remediate local physically pathological conditions of the body or the social conditions of epidemic contagion, which is not all medicine does but is right of course.

    • I agree, travailler-vous. But I think the psychiatric industry is holding on to their last thread, their claim that schizophrenics absolutely need to be medicated.

      But the reality, according to John Read’s research, is most schizophrenics today are people who suffered from adverse childhood experiences or child abuse. They’re victims, not dangerous predators, as the psychiatric industry propagandizes.

      And I know I was told by an ethical pastor that “the dirty little secret of the two original educated professions” was that the psychiatric industry has historically been in the business of covering up child abuse for the religions, and my medical records and research prove they still are.

      So I think it’s important we point out the reality that the “gold standard” treatment for so called schizophrenia is, in fact, known by the medical community to cause both the positive and negative symptoms of schizophrenia, and is regularly being misdiagnosed as the major mental illnesses. Since the mainstream psychiatric community absolutely does lie to their patients about this fact.

      I’d like to get the psychiatric industry out of the business of defaming and torturing child abuse victims, which the medical evidence now seems to prove, is the primary function of the schizophrenia diagnosis. And since this is the psychiatric industry’s seemingly last thread of credibility or respectability or validity. I hope to see the schizophrenia diagnosis discredited, as well.

      The “gold standard” treatment for schizophrenia actually causes the positive and negative symptoms of schizophrenia. And claiming child abuse victims, who’ve been made psychotic with drugs, are dangerous to all of humanity is disgusting and wrong.

      In a decent society, we’d be putting the child molesters in jail, rather than defaming and further torturing the victims of child abuse.

      • Let me tell you where head is at, basicalky, about general things that apply to me and my own case, Someone Else, so that you can see what points of your own you can connect from. I don’t want to go into the what happened question in detailed respects, but everything wrong with me is something occasioned by abuse, bad medicine (juju would have been better in the end) and talking cures (there have been clearly positive and “life-saving” exceptions, but more waitresses, cops, lawyers, and bus drivers have listened with natural interest and helpful feedback overall), and imminently fatal endangerments throughout my life (such is life). Some of these violent encounters were hostile and intended, but mostly it was accidental and traffic related sudden threats of death, dismemberment or disfigurement that seemed to set the standards for maladaptive reactions much later on, and the disabling CNS functioning that came on eventually with repeated doses of lousy treatment and malicious intent aimed at me later on–and that order is significantly causal, here, btw. That I didn’t cause a single one of these incidents suggests that they get called bad luck. Ok with me, in survivor terms, unforgiveable in justice terms. Certainly an eye for an eye is also not adequate. What you need is to alterations in the scheme of things and how people themselves have re-formed, and now repudiate their former antisocial justifications for themselves and their wrongdoings. That my response wasn’t to mope, shiver, and complain a lot made me worth less for people who say they like to help by talking to you, I do believe. But if anyone needs to mope, complain, and shiver, I feel sorry for them, too. I never saw a lot of acceptance going on, although tuning in to tge exceptional moments for myself and others and respecting and appreciating genuinely good listeners was and is my thing. You have to include the basic humanity of anyone who shows that in your vision of the possible, you know. Nevertheless, as far as licensed mental health professionals who have influenced my chances in life, what they could have helped with but instead didn’t, I could never see how to fathom, and all this incredible impatience of mine was for was just that they would try giving me advice about my cognitive issues and point out how to learn more about my problems (in thinkibg, feeling, and behaving) over all. That sounds so simple, but it was impossible to get done by shopping around for “relationships” any better or any more than I could trust myself to do as unlicensed efforts for myself. Mostly this was because of incompetence in clinical practice, strictly speaking, at least insofar as anything that I would train and give license to were I charged with the responsibility. Hence, the main issues with poor services in the fields in question stem from problems engendered and maintained by the total manifestation of the liberal Academy with its pretexts of self-sufficiency in preparing tomorrow’s workforce and the grand wizardry of its so hotly competitve inner workings. Next most often harmful for me, after outright inadequate preparation for their job, were the too often strange and unfriendly attitudes and bureaucratic mindsets pervasive throughout the industry, often enough worn like the cultural badge of honor it has eventually become. Last and least were the systemic problems associated with managed care. Go here, No, now there, Sorry, those were two good sessions but I have to switch to another town to practice, and my favorite, “Where is Doctor Lisa ______?” “Oh, you’re back with Dr. Joe.” What a laugh. And they mainly work in group formation to get you isolated from yiur natural support system, and work together to make sure they sell you drugs, and just their drugs, like it or not. What a lost cause. Anyway, my issue very briefly as it corresponds to self-interests that keep you yourself busy learning how to study the Big Biz in the decade of the Brain (when is that not? I want to know), returns to this…. The best description of my problem in living in its main aspects shows up in a very good description of a long dead psychiatrist in the opening pages of the CBT manual for DPAFU, and the information is all downhill from there. The PTSD manual from the same clinical group really is not very good for much, but Oh, the measurements! and Oh, the science! is all we hear. For my part, I see the evaluation and exercise instructions to rather poorly encompass the psychiatrist’s appreciation of the phenomenality of the experiences assigned to the types of disorder. Understanding that it is some total kind of arrangement of disorder that I live and not some discrete and separable disorder that I have it definitely one very central fact that helps me to know, but these books like most caregivers everywhere just go along with whatever make believe is most expedient for them and their careers to go along with. I have understood that my disorder of agency can wholly be described as abnormal deviations in what is called intentionality in theories of agency and consciousness. But the manual approaches and vast majority of clinicians narrow very nearly everything down to fit the mapped out service options wherever anybody lives, and these all have first to do with doctors and other caregivers and assistants earning a name for themselves (of course only so much of one, it’s not glamorous in very many instances) and their paycheck and their scrubs. They get to live the unblemished life without those terrifically reassuring and inconspicuous labels, most of them. Many do know how to turn that into a thrill, too, I promise. Oh, these so hard to come by facts about these trades, what a bother. Most of the folks actally know very few right things to look for to see the unique aspect of any case they help to handle, and most contribute nothing but business as usual in the form of rounds of say-so to their clients and their charges, although mere smiles keep some people from going berzerk or ending their lives, I’m pretty sure. But I doubt you can help anyone whose needs are serious, over the long run, by making believe with them that there are these classes of drugs for these kinds of diseases and altogether alarming and bona fide threats that they don’t realize they probably are intending to carry out, and the doctor guessed them, so they have to stay locked up–and call that modern, humane care and bill them for it, and do a lot of good. But it is what is going on, mainly, all finally to prove that stigma is really bad and has to be fought with your help, too, by staying compliant and showing string dedication to the saviors one and all. Thanks for showing some old-fashioned curiosity, S. E. That’s like a weight off my shoulders.

    • Mark – I think you’re right, and that no matter the particulars of how sufficiently correct and true your idea is, what the necessary conceptions for reliably determining psychopathology are, they have to meaningfully indicate that the dogmatic conception of behavioral symptoms as medically decisive ones is the central theoretical and practical flaw in the curriculum for the behavioral sciences, and the incredible inappropriateness of the expensive approaches to behavioral healthcare we see now. Thought, feeling, and behavioral symptoms become pathenogenic entities in bad explanations, and then both the problems in living and the person at odds with themselves in the world are lost sight of. This is indeed the thought deriving from the mental habit of putting people into molds that fit their label. That is how mental illness gets construed as a reactive feature of physical processes in the brain, instead of a facon de parler and a myth. That is how people keep getting injured and killed, by legally mandated treatments, and by simpler, not infrequently well intended efforts to get people to accept the help they need to straighten themselves out, although so very plainly and liberally misguided efforts, no matter the body count. And never mind the loss of moral dignity and free choosing of their own purposes. Thanks for remembering the debacle going on here in the less free than ever country so clearly and instructively.

    • B – Listen, the fact is that zonker medication can bring feeling back into focus if you have gotten out there and too diffuse with it or too ungrounded or too estranged from what your anxiousness was about. Pick the description that seems to fit the imaginary or remembered case of getting uncomfortably out there with how your feelings start to resonate too shallowly with your body. The problem is the protocols thereafter the desired effect is achieved are too doctinaire and misguidedly applied. All is oversimplification in hospitals with the diagnostic assumptions programmed into the psych-bot squads. You have your “true” problem “unmasked” or since the “right” drug worked they know “which disorder” was “cured”, etc. Not only does this go on forever, it’s neverendingly a pitiful laugh and every bit as disturbing to contemplate as Someone Else suggests. But it’s a breeze to balance your remarks and include the fact of happy accidental moments of recovery happening simultaneously to getting treated for the inappropriate label. The hard thing is the hospital over there with the clueless hammering the powerless like they are human nails. My recovery of feeling on monkey barrel doses of Seroquel was inappropriate treatment protocol. But it worked. If we had good instead of totally entitlement-rentseeking doctors here, that would have gotten examined for potentially being an off-label prescription success. But let’s not start asking questions too fast, mad doctors! But for my flipping out about having lost my perspective to depersonalized reflections and whatever else, since episodes of panic used to visit me a lot, just overlapping and repeating on top of each other, and determine all sorts of quasi-attention deficits and space me out worry me, the Seroquel just the one time was worth it. The culprit bottomline was massive stress, though, so that doesn’t mean Seroquel answered as the necessary thing, it just was the thing tried. Sedatives proper would probably have been better, but Oh, no, not that.

      So, anyway, as I sit recalling this, it’s also the case that my emotions are percolating less distractingly in regard to how come there is so little very fine-grained criticism aimed at the decrepit paradigm from within, from the academy, & from the press. And that’s good. We see more of our share of the telling signs of the mental health industry under fire because of the labors of, generally speaking, very true critics here on MIA, and necessarily also see more to general significance of the intermittent or even steadily increasing appearance of overt criticism in the wider free press. But it’s like we are seeing the pregnant women more now that the neighbor is showing. On the other side of the coin, people who haven’t gotten forced or blithely duped into using the standard run of assembly line services are themselves as unalerted as ever to the exact height of the conflict between those dismissive of psychiatry-led behavioral science culture, and its greatest lackeys.