Schizophrenia and Psychosis

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?

Robert Neugeboren, who “spent most of his adult life in institutions, often subject to isolation, physical punishment and numbing medication,” was “a celebrity of sorts in the world of the mentally ill: a survivor of the horrors of mistreatment, a case history for those who point to the positive effects of kindness and talk therapy, and, perhaps most of all, the embodiment of the bottomless mystery of the human mind.”

In a Science Update, the National Institute of Mental Health (NIMH) reports that Medicaid services is already taking steps to implement “coordinated specialty care” (CSC) in response to the RAISE study released last week. “The RAISE initiative has shown that coordinated specialty care for first episode psychosis is better than the standard care offered in community clinics. However, covering the cost of coordinated specialty care can be challenging. When Medicaid agrees to pay for effective treatment programs, patients in need benefit.”

Last Tuesday, The New York Times and several other outlets (including Mad In America) reported on the highly-touted results of a study on psychosocial treatment for patients diagnosed with schizophrenia. Now, claims made about the study, which the ‘Times called “the most rigorous trial to date,” are coming under increased scrutiny.

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.

A California jury ruled that Johnson & Johnson’s Janssen Pharmaceutical and a psychiatrist were responsible for the death of 25-year-old Leo Liu. During a clinical trial for Risperdal, Liu died of a heart injury that was “further complicated” by the drug and ignored by the study doctors. Janssen was found 70% responsible for Liu’s death and ordered to pay $5.6 million to the family.

Yesterday, the New York Times reported that schizophrenia patients in an experimental treatment program (RAISE) who experienced better outcomes had been on lower doses of antipsychotics than normal. However, the article published in the American Journal of Psychiatry on Tuesday did not divulge any data on the varying antipsychotic drug doses in the different study groups.

Results of a large government-funded study call into question current drug heavy 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 smaller doses of antipsychotic drugs with individual talk therapy, family training, and support for employment and education had a greater reduction in symptoms as well as increases in quality of life, and participation in work and school than those receiving the current standard of care.

Johnson & Johnson is exposed to personal injury and product liability lawsuits over the failure to warn about Risperdal gynecomastia side effects in boys.

Writing for CounterPunch, Paris Williams writes that when an individual is experiencing what has been termed “psychosis,” it is important to recognize that this may also be the manifestation of a breakdown in their larger social groups, the family, society, and even the species.

Journalist Emma Reynolds profiles Amanda Waegeli, Ron Coleman, Nathan Grixli and Lyn Mahboub about their experiences coming to the Hearing Voices Network (HVN). HVN was established 10 years ago in Australia and provided a support group that encouraged people to listen to their voices rather than trying to block them out. The group now operates in 25 countries.

The University of Minnesota recently announced that it is ending the controversial practice of recruiting study participants from patients involuntarily being held in their psychiatric unit. In a commentary for Minnesota’s Star Tribune, bioethicist and MIA contributor Carl Elliot reports that the university has still not apologized to the patient who spoke out against this practice. Instead, “the university has done its best to discredit him.”

New research is investigating how “poverty reduction promotes cognitive and brain development.”

Individuals diagnosed with psychotic disorders have an earlier onset of psychosis if they have previously been exposed to prescription stimulants, according to new research currently in press in the Journal of Psychiatric Research.

New data on the effects of social support after early 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 diminish.

Antipsychotics are currently the predominant treatment for individuals diagnosed with schizophrenia, but there is an accumulating body of research that links the use of these drugs to structural abnormalities in the brain. A recent meta-analysis suggests that gray matter loss in the brain may depend on the dose and class of the antipsychotic.

New research finds that brain matter loss in patients diagnosed with schizophrenia is correlated with antipsychotic use, according to Psych Central. The analysis suggests that the continued use of antipsychotics is linked with progressive cortical gray matter loss.

This month’s issue of JAMA Psychiatry ran an editorial commenting on recent research revealing that the majority of youth prescribed antipsychotics have not been diagnosed with a mental disorder.

On Tuesday, NPR told the story of DeAngelo Cortijo. DeAngelo became a foster kid at age 3 after his mother attempted suicide. He was “diagnosed with bipolar and anxiety disorders, attachment disorder, intermittent explosive disorder or posttraumatic stress disorder,” and was prescribed “a combination of antipsychotics, antidepressants and stimulants, and was told that taking them was his only hope of being normal.” Through equine therapy, DeAngelo was eventually able to get off all of his medication. Now, California is hoping to pass reforms that would prevent foster kids, like DeAngelo, from being “prescribed antipsychotic drugs at double to quadruple the rate of that not in foster care.”

On Saturday morning, Susan Inman, writing for HuffPost Canada, published “What You’re not Hearing About the Hearing Voices Movement.” In it, she criticizes HVM for “failing to differentiate between the needs of people who actually have psychotic disorders and those who don't.” On Sunday the Bay Area Hearing Voices Network published an open letter in response, writing: “Ms. Inman has profoundly mischaracterized hearing voices networks (HVNs) and also demonstrates a troubling lack of understanding of the empirical literature on psychosis, optimal psychosocial intervention and recovery.”

“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.

Careful reductions in dosage levels of antipsychotic medications over time improved long-term rates of recovery and functional remission in patients diagnosed with a first-episode psychosis.

While most treatments have had "statistically significant" success in clinical trials, no common psychiatric or psychological treatments improve the negative symptoms of schizophrenia at levels that are "clinically meaningful."

-What does the balance of evidence say about the relationship between cannabis use and increased risk of psychotic reactions?

-Columbia University psychiatrist Paul Applebaum reviews the challenges of intervening early in psychosis before symptoms emerge, and of doing so in an ethically responsible manner.