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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by zazenducke on May 21, 2012, at 9:20:21
Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study.
Harrow M, Jobe TH, Faull RN.
SourceDepartment of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.
Abstract
BACKGROUND:The prevailing standard of care in the field involves background assumptions about the importance of prolonged use of antipsychotic medications for all schizophrenia (SZ) patients. However, do all SZ patients need antipsychotics indefinitely? Are there factors that help to identify which SZ patients can enter into prolonged periods of recovery without antipsychotics? This 20-year longitudinal research studied these issues.MethodA total of 139 early young psychotic patients from the Chicago Follow-up Study, including 70 patients with SZ syndromes and 69 with mood disorders, were assessed, prospectively, at the acute phase and then followed up six times over the next 20 years. Patients were assessed with standardized instruments for major symptoms, psychosocial functioning, personality, attitudinal variables, neurocognition and treatment.
RESULTS:At each follow-up, 30-40% of SZ patients were no longer on antipsychotics. Starting at the 4.5-year follow-ups and continuing thereafter, SZ patients not on antipsychotics for prolonged periods were significantly less likely to be psychotic and experienced more periods of recovery; they also had more favorable risk and protective factors. SZ patients off antipsychotics for prolonged periods did not relapse more frequently.
CONCLUSIONS:The data indicate that not all SZ patients need treatment with antipsychotics continuously throughout their lives. SZ patients not on antipsychotics for prolonged periods are a self-selected group with better internal resources associated with greater resiliency. They have better prognostic factors, better pre-morbid developmental achievements, less vulnerability to anxiety, better neurocognitive skills, less vulnerability to psychosis and experience more periods of recovery.
Posted by zazenducke on May 21, 2012, at 9:22:09
In reply to Some Schizophrenics better off without meds, posted by zazenducke on May 21, 2012, at 9:20:21
Posted by SLS on May 21, 2012, at 14:41:08
In reply to Re: link for study » zazenducke, posted by zazenducke on May 21, 2012, at 9:22:09
> http://www.ncbi.nlm.nih.gov/pubmed/22340278
What I see is a study that fails to report the severity of the index episode of schizophrenia for each patient that they followed. It is possible that the people who did well without taking antipsychotics were not that ill to begin with. These people had the insight to "self-select" themselves to discontinue their treatment. Of course, maybe the medication ACCOMPLISHED THE MISSION: achieve full remission without the need for further treatment.
I often have difficulty deciphering what the authors had in mind when they chose the words to compress the entirety of their paper into a brief abstract. I'm sure the experts have no trouble, though. They probably speak the same language. Perhaps the severity of the index episodes is taken into account in their statistics appearing in the full text.
I imagine that antipsychotics work well enough for some people such that they achieve a stable remission that allows for the discontinuation of these medications. This is true of antidepressants. I am guessing that case history is taken into consideration when making treatment decisions.
I have known a dozen or two people with various presentations of schizophrenia who were very thankful that they were treated with antipsychotics. I don't think this is a black or white issue, though. People come in all colors. For me, seeing is believing.
- Scott
Posted by SLS on May 21, 2012, at 14:46:42
In reply to Re: link for study » zazenducke, posted by zazenducke on May 21, 2012, at 9:22:09
By the way, what are your sentiments regarding the treatment of schizophrenia with antipsychotics? What are your conclusions regarding the content of the abstract you posted? Should we abandon antipsychotic pharmacotherapy entirely? Do you have an opinion?
- Scott
Posted by sleepygirl2 on May 21, 2012, at 16:58:19
In reply to Some Schizophrenics better off without meds, posted by zazenducke on May 21, 2012, at 9:20:21
I guess what I'm curious about is how they selected their sample of people. I like that they followed folks for 20 years.
Psychosis pops it's head up in individuals with all sorts of diagnoses.
I'd love for this study to be accurate, and truly reflective of the treatment of schizophrenia.
Posted by novelagent on May 23, 2012, at 16:35:30
In reply to Re: link for study » zazenducke, posted by SLS on May 21, 2012, at 14:41:08
I believe until very recently, it was standard to, after the first episode, prescribe an antipsychotic and then "re-assess" after a certain period. My doc at the hospital said this would happen six months in. That was a year and a half ago.
At the clinic where I see my doc, I asked about this, and was told the new trend is to wait a year, according to one counselor. My doc said the same thing, citing the Finish study. But my present resident doc I now see says it's 2 years, and the nurse who gives me my monthly Invega Sustenna injection, she's a PhD N.P., and she balked when I asked about this and gave me a hard time just for bringing it up. She said mental illness doesm't go away (not true, remission does happen, but I think she means it's just more dismally unlikely for schz).
Anyhow, the fact is that the more someone is off their meds for the first couple of years at least, the more this illness gets its grips into the brain, and the ditch is dug. I had nothing more than a 24 hour episode, I checked myself into the hospital the same day, and was treated with an atypical a couple of days later (the episode lasted until three days into Zyprexa).
So my prospects for enterting complete and total remission are pretty good-- I've been on depot medication ever since I was in the hospital a year and a half ago. I figure I'll give myself another few yesrs, and maybe test things out maybe 5 years out of the illness?
The problem is, there's brain damage that goes on during the psychosis, so that's the only downside of testing things out. Of course, I plan on doing it with some Invega pills by my side. and the moment I might hesr voices, I'm taking them. I don't mess around. Or I could wait until I'm closer to being a geriatric....
What interests me is how remission did occur in insane asylums prior to antipsychotics. "The Mind That Healed Itself" is a book written by someome who was a patient who recovered from mental illness, although I haven't read it.... it was written in 1912.
> > http://www.ncbi.nlm.nih.gov/pubmed/22340278
>
> What I see is a study that fails to report the severity of the index episode of schizophrenia for each patient that they followed. It is possible that the people who did well without taking antipsychotics were not that ill to begin with. These people had the insight to "self-select" themselves to discontinue their treatment. Of course, maybe the medication ACCOMPLISHED THE MISSION: achieve full remission without the need for further treatment.
>
> I often have difficulty deciphering what the authors had in mind when they chose the words to compress the entirety of their paper into a brief abstract. I'm sure the experts have no trouble, though. They probably speak the same language. Perhaps the severity of the index episodes is taken into account in their statistics appearing in the full text.
>
> I imagine that antipsychotics work well enough for some people such that they achieve a stable remission that allows for the discontinuation of these medications. This is true of antidepressants. I am guessing that case history is taken into consideration when making treatment decisions.
>
> I have known a dozen or two people with various presentations of schizophrenia who were very thankful that they were treated with antipsychotics. I don't think this is a black or white issue, though. People come in all colors. For me, seeing is believing.
>
>
> - Scott
This is the end of the thread.
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