Paradigm Shifts in the Treatment of Schizophrenia

Following is a synopsis of an upcoming seminar presentation by Henry A. Nasrallah, MD, Saint Louis School of Medicine:

Dr. Nasrallah offered enlightening historical touch-points on how psychiatry’s understanding of, and its approach to, schizophrenia have changed in the past 50 years. His goal? To challenge practitioners to rethink ideas about the disorder and how they care for affected patients. From a laundry list of comparative shifts, here are a few of Dr. Nasrallah’s “then” and “now” observations:

The old paradigm was: Clinical and functional deterioration are inevitable in schizophrenia. The new paradigm is: Complete remission and restoration of function are feasible in many patients when they are fully adherent to the treatment plan.

The old: Long-acting injectable (LAI) antipsychotics are a last-resort treatment, to be prescribed after a patient is stabilized. The new: Use LAI antipsychotics early in the course.

Old: Begin treatment when psychosis appears. New: Work to prevent conversion to psychosis.

Old: The disorder is considered a consequence of neurochemical dysregulation. New: Impaired neuroplasticity is to blame.

Old: Treatment is a matter of trial and error. New: We can apply pharmacogenomics to predict a patient’s response to various drugs and thus increase the likelihood of therapeutic success.


Where was this seminar??
I think my pdoc went. I hope I taught her a thing or two about sz.

Interesting - and perhaps of help to people, but unfortunately that doctor seems to be on the payroll for one of the pharma companies - so you have to take the perspective with a large grain of salt. That is - its likely biased because the guy is getting paid to say things like this that helps the pharma company sell its long acting medications.

I’m not saying its wrong - but I am saying that you should look to some unbiased sources of data before you take it too seriously:

"Poster 145: “Effect of Aripiprazole Lauroxil on Metabolic and Endocrine Profiles, and Related Safety Considerations in Acute Schizophrenia” will be presented by Henry Nasrallah, M.D., Chair, Department of Neurology and Psychiatry at Saint Louis University School of Medicine.

Unfortunately - there were many of the same types of “educational seminars” / marketing efforts by the pharma companies when all the “2nd Generation” of antipsychotics came out - and they all proved to not be a big improvement on the older “1st generation” anti-psychotics. Different side effects - but not necessarily better side effect profiles.


Oh - and the presentation is available online here:

Sponsored by Janssen pharmaceuticals and Genentech (Roche)

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I very much support SzAdmin’s comments relative to purely pharmaceutical interventions.

I have seen waaaaaay too much of what Dr. Sapolsky describes (at about 1:05:00 into his lecture at relative to nasty side effects owing to what I have directly experienced and observed in others to be OVER-MEDICATION, meaning “too high a dose” and/or “over too long a period of time.”

One will find =piles= of discussion about this by mental health professionals online if one digs a bit.

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