Use of psychiatric medications in schizophrenia and other psychoses in a general population sample

Our results may partly indicate that, especially in schizophrenia, the effectiveness of antipsychotics is not as good as expected.

Highlights

•In all diagnostic groups, higher symptom scores, and higher number of hospital days associated to use of antipsychotics. In schizophrenia and other psychoses, also poorer social and occupational functioning, and in other psychoses female gender and lower education associated statistically significantly with use of antipsychotics.

•A lack of current psychosocial treatment setting was found among a third of the schizophrenia subjects and over half of bipolar psychosis or psychotic depression and other psychoses.

•These results may for a part indicate that the effectiveness of antipsychotics is not as good as expected, and that there is an obvious lack of regular psychosocial treatment contacts.

Abstract

The information on the use of psychiatric medications in general population-based samples is limited. Our aim was to analyse the use of psychiatric medications and factors associated with antipsychotic use in psychoses in a general population sample. Fifty-five persons with schizophrenia, 21 with bipolar psychosis or psychotic depression and 20 with other psychoses from the Northern Finland Birth Cohort 1966 were examined at about 43 years of age. The frequency of use and dosage of psychiatric medication and the factors associated with the use of antipsychotics were analysed.

Antipsychotics were used by 85% of schizophrenia, 65% of bipolar psychosis or psychotic depression and 62% of other psychoses cases; antidepressants were used by 22%, 60% and 33%; and benzodiazepines by 42%, 35% and 10%, respectively. In all the diagnostic groups, higher symptom scores and a higher number of hospital days were associated with the use of antipsychotics.

In schizophrenia and other psychoses, poorer social and occupational functioning, and in other psychoses, female gender and lower education were also associated with the use of antipsychotics. Our results may partly indicate that, especially in schizophrenia, the effectiveness of antipsychotics is not as good as expected.

http://www.psy-journal.com/article/S0165-1781(15)30654-5/abstract?rss=yes

Great. Let’s take everyone off meds and see how it works.

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I think there’s a sizeable gap between suggesting all people be taken off meds and the acceptance that meds have definite limitations.

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Excellent. 100% agreed. Just wanted to make sure that point was understood by the many others here who sometimes have difficulty with thinking that things have to be totally one way or another.

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The question to ask having first accepted the limitation of meds is would you be functionally and/or symptomatically worse off for not taking meds. I’m not sure due to the nature of psychosis/schizophrenia/serious mental illness this is always best answered by the patient as opposed to a third party such as a clinician or family member.

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Very much agreed. AND I see unfortunate errors that occur in a mental health system that – under stress – sometimes get so authoritarian that it imposes its will on patients without exploring all the appropriate options for getting them on board to play an appropriate and effective role in their own treatment.

I know I may seem to be flipping from one position to another, but what clinicians see – and have to deal with – in the trenches is so all over the block that things can get very “fuzzy” and very frustrating. It’s rather like the “fog of war” at times.

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I could see a couple of reasons that people with SZ taking AP’s would need to be hospitalized more than BP or D:

They are more likely to stop taking their meds, even temporarily, and need to go in to restart drug therapy or for maintenance doses. Street/illegal drug abuse is high among SZ, which may cause psychosis leading to hospitalization.

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Why is the success rate that people recover from schizophrenia higher in cultures that don’t use psychotropic medications to treat it?

http://www.pbs.org/wgbh/amex/nash/sfeature/sf_forum_0430f.html

Show me two or three bipolars in ten who will even take a med. (Hey! Psychotic or not, we luvvvvvvvv being this way.)

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462006000200014&lng=en&nrm=iso&tlng=en

Possible #1 reason (for the thesis of the paper):

Survival stress may be worse, but it is self-evident and easy to understand, accept and own.

Keeping-up-with-the-Jones’s stress may not be as “bad,” but few seem to understand, accept and own it until they’ve made a mess of themselves and their children.

I dunno. Just a thought.