Psychosis risk no good excuse for psychiatric drugging

A study in England shows that psychiatric drugs should probably not be used on people at risk for developing schizophrenia. The story is in TODAYonline, Drugs not best option for people at risk of psychosis, study warns.

The study was conducted by 5 universities.

Published on the British Medical Journal website, the study found the frequency, seriousness, and intensity of psychotic symptoms that may lead to more serious conditions was reduced by counselling and CT [cognitive therapy].

Participants, aged 13 – 35, were given weekly CT sessions for a max of 6 months over a 4 year period.

Before the trial, international evidence estimated that 40 to 50 per cent of people at risk of developing psychosis at a young age would progress to a psychotic illness.

Apparently this figure was a gross over-estimation. The article says in a number places that this figure is closer to one in ten. In fact, it’s less than 1 in 10.

But only 8 per cent of patients in the study were shown to have made the transition.

These results have led researchers to suggest that neuroleptic drugs should not be used as the first line of defense for dealing with at risk youths.

Do neuroleptic drugs cause an even bigger problem once they have been introduced? We’ve got high relapse rates and low recovery rates for people maintained on these drugs. Although it may seem so, this question was not addressed by the study.

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5 Responses

  1. From the study, to be found at:

    http://www.bmj.com/content/344/bmj.e2233

    “..these findings have important implications for the proposal to incorporate a psychosis risk syndrome in DSM-V, raising questions about its utility as a predictive concept..

    “It (the study) should encourage a normalising, non-catastrophic perspective on their (the patients’) psychotic experiences..

    “The ethics of intervening before the onset of a disorder are always debatable, and this is especially so in relation to the use of antipsychotics for people in an at risk mental state, which often have significant adverse effects; for example, a recent systematic review concluded that some of the structural abnormalities in brain volume that have previously been attributed to the syndrome of schizophrenia may be the result of antipsychotic drugs,49 which has been recently supported by a high quality prospective study50 as well as experimental studies in healthy volunteers.51 There is also evidence that increased cardiovascular risk is detectable after first exposure to any antipsychotic drug52 and there is overwhelming evidence of weight gain induced by antipsychotics.53 On the basis of low transition rates, high responsiveness to simple interventions such as monitoring, a specific effect of cognitive therapy on the severity of psychotic symptoms, and the toxicity associated with antipsychotic drugs, we would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at risk mental state.”

    From:

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7863198

    “Conclusions Some evidence points towards the possibility that antipsychotic drugs reduce the volume of brain matter and increase ventricular or fluid volume. Antipsychotics may contribute to the genesis of some of the abnormalities usually attributed to schizophrenia.”

    The bmj site is a great resource; there are lots of related studies and links that you would be interested in.

  2. What I couldn’t find was the questions you get asked to see if you have a psychosis risk syndrome. Any-one know? The people I feel sorry for are the ones whose GPs wanted to enter them into the study even though they were not “help-seeking”. I would find that crushing – to go my GP with say a painful foot and be invited to volunteer to take part in a study on psychosis risk. I would wonder what I had said wrong. But perhaps in these days of “desirable attributes” people don’t mind so much.
    Actually, in this study, the people did get something in the way of treatment didn’t they – even the controls got a card or something. So maybe the low number of people becoming psychotic within a year means it was helpful.

    • It should be a thank you card.. Cheers and hey, by the way, sorry to hear about your foot(!)

      From what I can see, it is a proposed addition to the DSM-V:

      http://www.dsm5.org/proposedRevisions/Pages/proposedrevision.aspx?rid=412#

      The sensible view:

      http://www.psychologytoday.com/blog/dsm5-in-distress/201003/dsm5-psychosis-risk-syndrome-far-too-risky

    • Psychiatry doesn’t need to get into the business of soothsaying, and predicting who will or who won’t suffer a breakdown is exactly that, soothsaying. You’ve got the same problem in situations where treatment represents pre-crime rehabilitation. This need for treatment is based on the pseudo-scientists ability to predict the future. If events are malleable, as some of us think they are, then the potential for mistakes is very great.

      There are better ways to nip psychosis in the bud, for example, crisis respite. When people end up in hospitals because they can’t get enough sleep, or because they are in bad situations, or because they are in abusive relationships, providing them with a place where they can stay for a short while is preventative. The problems we have now stem from the fact that first episodes, in the system we’ve got, lead to second and third episodes. Sometimes these things happen merely because people don’t have any options. Give them an option, and the last resort ceases to be the only resort.

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