Schizophrenia and Psychosis

If you’ve been paying attention the last two years, you’ve seen the new DSM-5, as well as its predecessors, taking a beating from a variety of critics pre- and post-publication. Most have begun by noting the lack of construct validity of DSM’s diagnoses, dating from the landmark DSM-IIIR in 1987. Given the absence of scientific evidence to support their existence, these diagnoses were less likely to represent the neurobiological phenomena claimed by the DSMs’ several authors than to be products of their collective imaginations.

In the wake of the new study by Dutch researcher Lex Wunderink, it is time for psychiatry to do the right thing and acknowledge that, if it wants to do best by its patients, it must change its protocols for using antipsychotics. The current standard of care, which—in practice—involves continual use of antipsychotics for all patients diagnosed with a psychotic disorder, clearly reduces the opportunity for long-term functional recovery.

In this blog, I discuss three RCTs that support Martin Harrow's findings in his naturalistic study that long term use of neuroleptics is associated with worse functional outcomes.

Dopamine supersensitivity as a result of sustained antipsychotic treatment can lead to compulsive drug seeking and drug-taking behavior, according to the theory offered by...

While a 2-year outcome study by Wunderink, et al. has been cited as evidence that guided discontinuation of antipsychotics for people whose psychosis has remitted results in twice as much “relapse,” a not-yet-published followup of that study, extending it to 7 years using a naturalistic followup, finds that the guided discontinuation group had twice the recovery rates, and no greater overall relapse rate (with a trend toward the medication group having more relapse.)

In a systematic literature review, researchers from Canada and Japan found that the antipsychotic aripiprazole (Abilify) was significantly and causally related to increased increased...

When children do things like recoil in fear from monsters and ghosts in their darkened bedroom at night, it’s easy to see the “out of touch with reality” aspect of their experience as being closely related to the faculty that gives them their ability to play – their imagination. We help children through such challenging experiences by being with them, and by playing together, doing things like creating scary images together and then figuring out how to cope with them or laugh at them. In the process we help them explore how to create a world view that works to at least some extent and has room for joy and originality - when their imagination helps them (and maybe others) see the world in new ways.

If you haven't been labeled mentally ill by the American Psychiatric Association, you have to ask yourself what's wrong. Perhaps you were ahead of the game: you knew not to reveal yourself to them, you knew how to avoid them, you found other social support, and if so, a big congratulations. If not, what's wrong? Why have you conformed?

Schizophrenia Bulletin publishes a review of published articles that finds the use of schizophrenia subtypes (Catatonic, Disorganized, Paranoid, Residual & Undifferentiated), "while widely used...

What makes the DSM so pernicious is that it is a cultural document whose influence transcends not only psychiatric practice but also the Western civilization from which it originates. Each revision of the DSM rescripts and reimagines how we make sense of our experiences, reinterprets what thoughts, feelings and behaviors are socially sanctioned, and ultimately what it means to be human.

At the University of Minnesota, the answer is apparently $1,446. If harmless clerical errors were to blame for oddities like this, that fact should be easy to clarify simply by looking at the relevant documents.  But if there are systematic issues with the administration of clinical trials that makes it possible to bill for a visit with a dead subject, those issues would be important for other universities and private trial sites as well. 

While some people find their lives ruined by belief in imagined conspiracies that affect them personally - they may isolate from, or even attack, friends and family, and get diagnosed with psychosis - many other people believe in conspiracies on the basis of little evidence, yet have prominent places in society or even bodies like the US Senate. Yet it seems clear to me that the same dynamics are often involved in both.

Researchers in Germany, China and Australia teamed up to find, through a meta-analysis of research pertaining to 1045 patients receiving antipsychotics, that augmentation with...

French researchers looked at the outcomes of 467 "antipsychotic drug-naive" patients six months after a first psychotic episode (and treatment with medication), finding that...

Chinese researchers find, in a literature review for the International Journal of Endocrinology find an increased rate of osteoporosis among people with a schizophrenia...

Earth Day 2013 is a good time to reflect on how problems in our mental health system reflect deep flaws in “normal” conceptions of what it means to be a human being. These flawed conceptions then contribute in a critical way to the climate crisis that threatens us all.

For the past 20 years, there has been a prevailing concern in psychiatry that psychosis is bad for the brain. When I read Anatomy of an Epidemic, this was one of my most pressing concerns; if I suggested to my patients that they pursue other treatments before starting drug treatment, was I helping or harming them?

British researchers find that a 10% increase in pain medication resulted in a dramatic reduction in the use of antipsychotic and other medications. “When...

The Cochrane Library reports that "many older people with Alzheimer's dementia and NPS (neuropsychiatric symptoms) can be withdrawn from chronic antipsychotic medication without detrimental effects...

The label of schizophrenia has a chilling ring. It carries with it the suggestion of a wrecked and wretched life. It is also a diagnosis that is notoriously difficult to shed. For this reason, the diagnosis of schizophrenia should not be applied lightly and not without a thorough understanding of the patient’s family and wider circumstances.

Despite the integral importance of blinding and blinding assessment to randomized controlled trials (RCTs), they are rarely reported on or documented in trial reports...

Martin Harrow and Thomas Jobe have a new article coming out in Schizophrenia Bulletin that I wish would be read by everyone in our society with an interest in “mental health.” Harrow and Jobe, who conducted the best study of long-term schizophrenia outcomes that has ever been done, do not present new data in this article, but rather discuss the central question raised by their research: Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Or does it hinder it?

Richard Bentall, clinical psychologist and author of Madness Explained presents new evidence for the limitations of anti-psychotic medication and of the psychiatric establishment. Institute of...

Psychiatrists at the University of Minnesota forced a young man into a profitable study of antipsychotic drugs over the objections of his mother, who desperately warned that his condition was deteriorating and that he was in danger of killing himself. On May 8, 2004, Mary Weiss' only son, Dan Markingson, committed suicide. A petition to the governor of Minnesota now asks for an investigation.

Researchers in London and Spain, in a prospective, randomized, study of long-term (3 year) effects of first- and second-generation antipsychotics on neurocognition in 79...