Antipsychotics

Researchers from Vanderbilt and Columbia Universities and the FDA find that, through a retrospective cohort study of 28,858 patients of the Tennessee Medicaid program...

In the 1950s, when the drugs we now call ‘antipsychotics’ first came along, psychiatrists recognised that they were toxic substances that happened to have the ability to suppress thoughts and emotions without simply putting people to sleep in the way the old sedatives did. The mental restriction the drugs produced was noted to be part of a general state of physical and mental inhibition that at extremes resembled Parkinson’s disease. Early psychiatrists didn’t doubt that this state of neurological suppression was potentially damaging to the brain.

Amid concern about side effects as well as the growing off-label use of antipsychotics to treat violent and aggressive behavior, the inspector general's office...

The first time I heard someone labeled schizophrenic I was about 10 years old. A man was talking to himself and appeared to be house-less and perhaps on drugs. My mom, a very good teacher and explainer of things to me, said, “That man is schizophrenic. That means he can't tell the difference between what's inside of himself and what's outside.” In retrospect this seems like a relatively sophisticated and sensitive explanation; Falling in love, hearing music that enters our heart, having children/giving birth, connecting powerfully with another person in a meeting of the minds, feeling empathy, deeply caring about something, experiencing oneness with nature, are all examples of times when the line between inner and outer reality is blurred.

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.

A study published today in the American Medical Association's journal JAMA Psychiatry reports that patients whose antipsychotic treatment was reduced or discontinued (DR) experienced a recovery...

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...

Research by Andreasen et al. published in American Journal of Psychiatry in June of 2013 reported that the dosage of antipsychotic medication correlated with the reduction in the cortex volume; higher dosage was associated with greater reduction. In that same article, the authors suggested that, since they found brain shrinkage correlated with duration of relapse, curtailing or preventing the relapse would probably decrease damage. Their suggested mechanism for shortening the relapse process was to prescribe more drugs. Before advising fellow physicians to increase the dosage of antipsychotic drugs to prevent brain volume reduction, it is important to show the following: first, demonstrate that symptoms, in fact, reflect the occurrence of a damaging process; second, demonstrate that any treatment intervention actually targets the damaging process itself and not just the downstream symptoms of this process.

Evidence that antipsychotics cause brain shrinkage has been accumulating over the last few years, but the psychiatric research establishment is finding its own results difficult to swallow. A new paper by a group of American researchers once again tries to ‘blame the disease,’ a time-honoured tactic for diverting attention from the nasty and dangerous effects of some psychiatric treatments. People need to know about this research because it indicates that antipsychotics are not the innocuous substances that they have frequently been portrayed as. We still have no conclusive evidence that the disorders labeled as schizophrenia or psychosis are associated with any underlying abnormalities of the brain, but we do have strong evidence that the drugs we use to treat these conditions cause brain changes.

The Food and Drug Administration is investigating the deaths of two individuals who died three to four days after injections of "an appropriate dose"...

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...

Johnson & Johnson is negotiating with federal authorities over language that might be used in dozens of civil lawsuits regarding abnormal breast development and...

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...

In previous posts in this series, I noted that the standard treatment of conditions labeled as schizophrenia (and related disorders) is to start neuroleptics early and to continue them indefinitely. This is based on the belief that untreated psychosis is bad for the brain and that relapse is much higher when the drugs are stopped than when they are continued. The rationale for this approach, and my discussion of the limitations of these assertions, were the topics of previous blogs in this series. In this final post I want to discuss how realistic this paradigm of care is.

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...

A major research group mentions in a paper published in an academically rigorous psychiatric journal (and I get it that some readers consider that an oxymoron) the possible influence of super-sensitivity on increasing the risk of relapse when neuroleptic drugs are stopped. Yet those of us who raise this as a reason to moderate our use of these drugs are considered biased or scientifically naive.

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.

Yesterday I attended psychiatry grand rounds, where Andy Miller presented his latest research. Andy has been a pioneer in the field of psychoneuroimmunology and an exponent for the view that major depression reflects systemic inflammation. (I have published a review of this literature recently in Frontiers in Psychology which is available for download).

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?