The clinical implications of our findings may be as follows: we can expect the benefits of antipsychotics for patients with full spectrum of severity who are likely to treat for acute schizophrenia and for highly symptomatic patients with predominantly negative symptoms, and the severer the illness is at baseline, the bigger the benefits will be.
and
Towards the mildest end of the spectrum, judicious clinical consideration of trade-offs between benefits and risks of the antipsychotic treatment is required.
Discussion
What surprised me most about this paper was the use of data from old trials to develop and test this model. The included data ranged from papers published between 1993 and 1999 and the data would have been collected before this. This is not clearly identified in the paper. For the authors to only be allowed access or get access to 6 of the 97 trials is terrible. It is clear that this paper was supported via drug companies and their role in this is unclear, particularly whether the authors could only access certain data.
From a clinical perspective it is useful to know that those with the worst symptoms (either negative or positive) are likely to improve more as a result of prescribing an antipsychotic vs placebo. But the review only included three of the commonly prescribed antipsychotic drugs, and there was no discussion about optimum dosages. However, the outcome of these trials were measured at 6 weeks, so this does not help clinicians understand the longer term implications of antipsychotic prescriptions.
Supported via drug companies/unclear whether could only access certain data/outcomes measured at 6 weeks. That combination doesn’t sound good although it makes sense the milder your psychosis is the less difference an antipsychotic should make.
Why are there so many that say they are med resistant? Is it they just don’t give the meds enough time or something else? I ask as It’s mostly them that seem to suffer with more psychosis.
I wonder how this research translates to people who are categorised with so called non psychotic diagnoses like borderline/paranoid PD/ schizotypal(although there may be brief psychotic symptoms) who are prescribed antipsychotics.
I think a big problem with med adherance , is that many people have a life time of abnormal thought processes , they know no different , and when meds begin to change that , they believe they are being robbed of their core personality. Its an affront to their very soul.I lived a life of rumination , had constant oppositional thought processes , was oppositional and defiant in personality (to the point of mass upheaval) I accepted this was normal. The problem is, as the psychosis become more and more intrusive , I had to shout louder and louder to be understood. My personality was gradually being changed by stealth and when it all blew up , I was so far off course , I was totally unequipped for the world.
When I was younger I was given a course of ECT and my voices… my life long voices were gone… vanished… one go… and my head for the first time was silent…
As a result… I flipped out worse. I was SURE the hospital took my brain. I was so internally off balance… it was so quiet in my head… it physically hurt.
The docs were thinking… “hey… no voices… that must be better”
Not to me… it was scary to have my head erased so fast. When I got out of hospital I RAN back to the illegal drugs to get my voices back. I remember actually being happy when they came back. I knew where I was in my head again.
I wish there was a way to communicate to the docs… after a life time of coping with this head circus… erasing it in one go is too much too fast. Little by little… and the compliance rate might be better.
I’ve been helped enormously by my Risperdone. I was really sick when I went to the hospital both times. My uncle who had SZ couldn’t hold a job or anything. It worries me that when I relapse, I will really check out.