Dr. Tom Insel, chief of the National Institute of Mental Health, has written an important post on his blog at the NIMH website. He has focused on two recent studies that call into question traditional medical model treatment assumptions for schizophrenia. The first study, by Wunderink et al. (2013), shows better recovery outcomes after sevens for those with schizophrenia no longer on their antipsychotic medications. The second study, by Harrow and Jobe (2007), indicates lower relapse rates over time of those with psychiatric disabilities who have discontinued medications. These studies call into question the efficacy of long-term antipsychotics usage. As Dr. Insel concludes from both articles, we need to broaden our understanding of schizophrenia–including a rethinking of additional modalities of psychiatric rehabilitation care:
It appears that what we currently call “schizophrenia” may comprise disorders with quite different trajectories. For some people, remaining on medication long-term might impede a full return to wellness. For others, discontinuing medication can be disastrous. For all, we need to realize that reducing the so-called “positive symptoms” (hallucinations and delusions) may be necessary, but is rarely sufficient for a return to normal functioning. Neither first nor second generation antipsychotic
medications do much to help with the so-called negative symptoms (lack of feeling, lack of motivation) or the problems with attention and judgment that may be major barriers to leading a productive, healthy life. Family education, supported employment, and cognitive behavioral therapy have all demonstrated efficacy in reducing the likelihood of relapse events, increasing the ability to function in daily life, and improving problem-solving and interpersonal skills.
Harrow, M., & Jobe, T. H. (2007). Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: A 15-year multifollow-up study. The Journal of Nervous and Mental Disease, 195, 406-414.
Wunderink, L., Nieboer, R. M., Wiersma, D., Sytema, S., & Nienhuis, F. J. (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: Long-term follow-up of a 2-year randomized clinical trial. JAMA Psychiatry, 70(9), 913-920. doi: 10.1001/jamapsychiatry.2013.19