Posted by SLS on January 6, 2007, at 13:07:25
In reply to the case for neuroleptics is kind of weak, posted by med_empowered on January 6, 2007, at 11:50:21
Good post, M_E.
There are a few things that I would like to address, but I gotta run.
One thing that strikes me as funny, though, is that a statement like this: "I think arguing that there was a problem in diagnosis reflects an unwillingness to find out what's going on here." is so quickly made in a forum where so many people berate the ability of psychiatrists to properly diagnose patients - or even if there is really anything consistently reliable to diagnosis at all.
As you said, I do think something is wrong here, and I would like to know what it is.
- Scott
> the studies are WHO studies...there were 2 of them, and I think the last one was done in the early 1990s. All the patients were DX'd by the same criteria--I think it was the ICD-10 definition of schizophrenia, not the DSM-IV--and followed up for a number of years. Apparently, in less developed countries, fewer patients were ever placed on neuroleptics, and very few were maintained on neuroleptics. Wealthy countries had low success rates in schizophrenia, as measured by continuing symptoms and more important things, like jobs and social integration. Poorer countries did much better in terms of relapse, social integration, and severity over the course of the study.
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> Since the countries involved had widely different cultures, I think the low use of neuroleptics has to be considered a possible factor. I think arguing that there was a problem in diagnosis reflects an unwillingness to find out what's going on here. The diagnostic criteria applied was quite sound and was applied uniformly; I think the problem is that in much of the world, schizophrenia is considered to have a very poor prognosis, so if a patient (or large group of patients) end up doing well, then the assumption is "well, it wasn't schizophrenia, after all". That is circular logic at its worst.
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> Apparently, there were studies early on in the days of neuroleptics that tended to show longer hospitalization times and more social dependency (welfare, etc.) in patients treated with and maintained on neuroleptics than with patients treated with non-neuroleptic methods (mainly psychosocial intervention). Also, Courtenay Hardening did a study in the 80s in which she tracked down patients (many backwards) who had been treated w/ psychosocial programs. Surprisinly, LOTS of them recovered fully or to a meaningful extent, and the ones who either stopped neuroleptics or never took them were among the best cases. Also, there was subgroup of patients who took very low doses of neuroleptics only when necessary, and they were also doing quite well.
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> Plus, there are shrinks now who are calling for looking at schizophrenia as a variant of bipolar, and using anticonvulsants and lithium in place of the neuroleptics. Some studies have also shown positive effects from high-dose diazepam and propranolol therapies.
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> Also, over the course of the illness, neuroleptics increase mortality. They increase seizures, obesity, liver problems, heart problems, and sudden deaths. Compared to patients not treated with neuroleptics, there may also be an increase in suicides, even with the atypicals. (Although clozapine is claimed to reduce suicide--I don't know if this is compared to older antipsychotics or to untreated schizophrenia, though).
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poster:SLS
thread:719688
URL: http://www.dr-bob.org/babble/20070101/msgs/719849.html