No Treatments Have “Clinically Meaningful” Impacts On Negative Symptoms of Schizophrenia

Rob Wipond
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While most treatments have had “statistically significant” success in clinical trials, no common psychiatric or psychological treatments improve what are termed “negative” symptoms of schizophrenia at levels that are “clinically meaningful,” according to a meta-analysis in Schizophrenia Bulletin.

Led by King’s College London researchers, the study stated that there has been a great deal of focus on treating, and some degree of success in reducing, “positive” symptoms of schizophrenia such as hallucinations and delusions. However, less attention has been paid to whether common treatments are helping reduce or improve “negative” symptoms such as “diminished expression of affect,” disengagement, disinterest, social withdrawal, and impaired functioning in daily tasks.

The researchers searched for all randomized-controlled trials of interventions for negative symptoms in schizophrenia published before December of 2013. They examined 168 trials involving 6,503 patients in treatment arms and 5,815 patients in placebo groups.

The researchers found that virtually every major treatment approach — atypical antipsychotics, antidepressants, glutamatergic medications, drug combinations, and also psychological interventions — all helped reduce negative symptoms at “statistically significant” levels. And they also stated that there was, “No evidence of publication biases found.” Only first generation antipsychotics and brain stimulation techniques failed to produce statistically significant outcomes.

However, the impacts of the “effective” treatments, though statistically measurable, were generally so small that they were not truly meaningful when evaluated for their actual impacts on people’s “level of functioning or quality of life,” the authors wrote.

“Although some statistically significant effects on negative symptoms were evident, none reached the threshold for clinically significant improvement,” they concluded.

Fusar-Poli, Paolo, Evangelos Papanastasiou, Daniel Stahl, Matteo Rocchetti, William Carpenter, Sukhwinder Shergill, and Philip McGuire. “Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials.” Schizophrenia Bulletin 41, no. 4 (July 1, 2015): 892–99. doi:10.1093/schbul/sbu170. (Abstract)

13 COMMENTS

  1. Kings College (/The Maudsley) Are WRONG: There is a treatment that works effectively for the “Negative Symptoms”.

    I was diagnosed in 1980 initially and then diagnosed chronically in 1983/4. But by 1985 I was back into responsible employment, and have remained well since.

    My treatment involved: Coming off a long acting injection, and moving to Psychotherapy.

    I was originally injected with long acting medication in 1980 by a Maudsley (/Kings College) doctor because I had ‘declined’ medication – asking instead for Psychotherapy.

  2. Did these researchers take into account the fact all the antipsychotics / neuroleptics are known to cause the negative symptoms of schizophrenia via neuroleptic induced deficit syndrome? From Wiki:

    “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 these neuroleptic induced negative symptoms of schizophrenia are misdiagnosed and mistreated with higher doses, and / or more neuroleptics this can result in the central symptoms of neuroleptic induced anticholinergic intoxication syndrome, which emulate the positive symptoms of schizophrenia, except the person is hyperactive, rather than inactive? From drugs.com:

    “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 central symptoms of neuroleptic induced anticholinergic intoxication syndrome would give the appearance to psychiatrists of a decrease in the negative symptoms of schizophrenia, because the patient would become hyperactive (although also psychotic, etc.).

    But making people hyperactive and psychotic, with the neuroleptic drugs, is not actually going to improve a person’s life.

    And if these adverse effects of the neuroleptics were considered, and controlled for, which they don’t appear to have been, by these researchers in this study. It is highly likely the finding that “virtually every major approach — atypical antipsychotics, antidepressants, glutamatergic medications, drug combinations, and also psychological interventions — all helped reduce negative symptoms at ‘statistically significant’ levels,” would be found to be untrue. And there would be absolutely no “statistically significant” improvement whatsoever for any of these treatment methods.

    • I agree with you, generally, except for one thing….
      All these “treatments” involve some human contact, right?
      Human contact with caring, helpful medical people, right?
      So, it’s the very act of socialization *itself* which is causing the
      APPARENT “improvement”.
      And, am I the only one who sees that the drug effects PRODUCE the apparent
      “symptoms” in the first place?….

      • “Human contact with caring, helpful medical people, right?”

        That may be true except that I am yet to meet a psychiatrist who can provide the caring/helpful contact. Most of them would easily fit a description of a psychopath.

  3. Neuroleptics undoubtedly cause a lot of these problems. I think there’s other issues, as well, such as social isolation and poverty, that are being “diagnosed.” Is there an anti-poor pill? Can I have one?

    Neuroleptics are very powerful drugs. I’m stuck on one…newer one…and its OK. I do hardcore Orthomolecular with it, so at least I can tolerate it and its non-sedating. Still, the Orthomolecular people have a term for the tranquilizer’s effects on people, which they borrowed from some 50s British shrink (back before tranquilizers became required treatment): the “tranquilizer psychosis.” The Orthomolecular shrinks are remarkably honest about how tranquilizers can switch one psychosis–the “positive” symptoms, I suppose–for another one…the so-called “negative symptoms.” Neither form of psychosis lends itself well to…well…living all that well.

    Personally, I think that madness+stigma+social isolation+low status+(usually) poverty=a lot of what experts choose to call “negative symptoms.” Plus, “schizophrenics” can’t really win. Everything about us/them is apparently diseased and disordered. Considering that the label itself is often applied to people already low(er) on the totem pole–poor people, minorities, etc.–and I think you can see what the real problem is. It isn’t just that shrinks don’t listen to “schizophrenics” (although they don’t, trust me), its that shrinks choose to call low status people “schizophrenic” and then there’s a whole new level of stigma and labeling (poor and “schizophrenic.” Minority and “schizophrenic.” Drug addict and “schizophrenic.” Unemployed and “schizophrenic.”)

    A part of me wonders if the “negative symptoms” maybe represents low status people taking a little vacay from their/our lot in life…which shrinks do not allow, of course. Everything about a “schizophrenic” person’s life is apparently supposed to be under control of Mental Health, Inc.

    • Yeah_I_survived,

      “Orthomolecular medicine describes the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body.” How orthomolecular can your shrink be if he / she is prescribing neuroleptics, which are not actually “substances which are natural to the body”? Although, I’m glad your treatment is working well for you.

      I do agree psychiatrists are attacking people they have delusions have no money. According to my medical records, I was misdiagnosed as “bipolar” based upon lies from some wealthy child molesters who’d illegally gone into two income statements of mine at my children’s private school, while I was a stay at home mom and my husband had just change careers, and extrapolated that into their delusions that my $250,000 net worth at the time and parents millions, weren’t enough of a net worth to join a particular church. And, of course, once you’re misdiagnosed, then defamed to your family, and massively tranquilized, it’s really easy for others to steal all your money. And the whole world should be made aware of the fact that getting a person psychiatrically labeled and tranquilized is a fabulous way to steal someone’s money.

      I also agree, “It isn’t just that shrinks don’t listen to “schizophrenics” (although they don’t, trust me),” or those who had ADRs from bad drug cocktails your PCP was putting you on misdiagnosed as “bipolar.” Some decent nurses in my PCPs office finally got disgusted at my PCP for overseeing the massive poisoning of me, due to her desire to cover up her husband’s “bad fix” on a broken bone of mine, and the cover up of the medical evidence of the sexual abuse of my little child, and handed over my family’s medical records.

      I read them, and was amazed at all the misinformation in my psychiatrist’s medical records. On my second to last appointment with him I confronted him with all his written delusions, and the fact the medical evidence of the abuse of my child had been handed over. The psychiatrist freaked out and declared my entire life, everyone I’ve ever met including the child abusers, the universities I’d graduated from, the places I’ve lived a “credible fictional story” in his medical records.

      Then he asked to have my husband come in with me on my next appointment. And tried to convince my husband that I needed to be put back on every single neuroleptic drug that I’d already been taken off of because each made me sicker than hell. All at the request of the psychologist who’d misdiagnosed me based upon lies from her child molester friends and unethical pastor.

      Psychiatrists are in the business of aiding and abetting child molesters, unethical pastors and child abuse covering up religions, incompetent doctors, and thieves. This is known, according to a subsequent ethical pastor of mine, as the “dirty little secret of the two original educated professions.” How is one ever to have respect for pastors and the medical industry once they are aware of this “dirty little secret” of the medical and religious communities, who both profit tremendously from such crimes against humanity?

      If you ever do decided to give up the schizo label, and go off the neuroleptics, do expect a drug withdrawal induced manic psychosis – and do everything you can to stay away from the hospitals, because they will misdiagnose that known withdrawal effect of the neuroleptics as a return of your original “disorder.” My best to you, yeah_I_ survived.

    • It’s very little, if any better, here in America. Any so-called “mental illness” is exactly the same as a present from Santa Claus. (I received MANY presents from Santa Claus as a child, so I KNOW Santa Claus is real….)
      It’s the same idea. The SAME IDEA.
      So-called “mental illness” = Present from Santa Claus.
      Hey, I’m not saying you aren’t crazy, or that you shouldn’t be on drugs….
      Only *YOU* can decide those things – or at least that’s how it should be….
      Also, try vipassana/mindfulness meditation, Yoga, and lots of walking or other physical exercise. That helped me greatly.

      Remember, schizophrenia is a present from Santa Claus….metaphorically speaking….

  4. As usual, these studies reified schizophrenia, one of the most useless invalid psychiatric fictions, and failed to mention that negative symptoms are simply perceptions by an outside observer of discouragement or apathy, not symptoms in any medical or physical sense.

    My viewpoint on this “finding”: There are no medications or brief supportive approaches that bring a delusional, discouraged, confused, hopeless, beaten-down, distrusting person back to full emotional life. (negative symptoms simply refer to the discouragement, apathy, and social disconnection shown in the most emotionally regressed, out of contact individuals).

    But there is a cure for these negative symptoms that is far more than statistically significant. It’s described in the following books:

    Treating the Untreatable (Ira Steinman), Weathering the Storms (Murray Jackson), Collected Papers on Schizophrenia (Harold Searles), Psychotherapy of Schizophrenia (Bert Karon), In Search of the Lost Mother of Infancy (Lawrence Hedges).

    These books describe 3-5 year+ intensive psychotherapy relationships in which previously hopeless, apathetic psychotic individuals came alive and returned to real relationships, became able and interested in work,etc.

    The reason why these psychiatric researchers never found the cure is that bringing a chronically hopeless, apathetic person back to emotional well-being usually requires several years of a close therapeutic relationships or otherwise supportive environment. Medication and the medical model approach to “schizophrenia” are usually obstacles to such progress, and it is no surprise that they usually fail at bringing the most distressed people back to life.

    • I think you’re very right about “schizophrenia” (as fiction) because everyone’s situation is different. I believe there’s no such thing as “schizophrenia” as an illness.

      As far as I can see, in “negative schizophrenia” the medication has a lot to do with the situation.

      • How do I encourage BOTH of you?
        Yes, so-called “schizophrenia” is an imaginary disease invented to
        sell drugs, and to enable quack shrinks to act as agents of social control…..
        It’s best seen as a present from Santa Claus.
        My “mental illness” consists entirely of the mistaken perceptions and belief
        in others’ minds, that I have such a thing, or that it’s real, in the first place….
        (To be fair, I was a pretty much scared & confused kid when I was first “diagnosed”,
        but that’s another book….

  5. “treatments are helping reduce or improve “negative” symptoms such as “diminished expression of affect,” disengagement, disinterest, social withdrawal, and impaired functioning in daily tasks.”

    Since these symptoms are largely caused by the drugs used to “treat positive symptoms” – not surprised.

  6. I think it’s funny that my negative symptoms started when I took antipsychotics for 7 days in a psychiatric hospital.

    I’m still taking antipsychotics, but I had to add another medicine for Alzheimer that’s helping with negative symptoms.

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