Paradigm Shift to Promote a Revolution of Treatment of Schizophrenia to Achieve Recovery
Main Article Content
Abstract
Active schizophrenia is characterized by psychotic symptoms that can include delusions, hallucinations, disorganized speech, trouble with thinking, and a lack of motivation. The introduction of antipsychotics in the 50ties was called a revolution for the treatment of schizophrenia and psychosis and is now a cornerstone of treatment. The effects are considered well documented. Guidelines suggest that all patients be offered antipsychotics. Nearly all patients are medicated. Concerns have been raised about non-responders, and there is no evidence for long-term effects. The validity of the diagnosis of schizophrenia according to the Diagnostic and Statistical Manual Mental Disorders (DSM) is controversial and discussed. Patients experience side effects and low benefits and try to stop. This is considered non-conformance, which can lead to relapse. Therefore, caregivers consider medication necessary and use forced drugging. Antipsychotics reduce psychotic symptoms. New patient laws in many countries aim to promote recovery.
The United Nations Special Rapporteur on the Right to Health has called 2019 for «World needs a "revolution" in mental health care». "There is now unequivocal evidence of the failures of a system that relies too heavily on the biomedical model of mental health services, including the front-line and excessive use of psychotropic medicines, and yet these models persist". However, this proposal is highly controversial for clinicians.
World Health Organization (WHO) followed up 2021: “New WHO guidance seeks to put an end to human rights violations in mental health care”. "This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support".
This is highly controversial; however, the United Nations High Commissioner for Human Rights (OHCHR) supported the WHO proposal with a guideline to reform legislation in order to end human rights abuses and increase access to quality mental health care. A realistic path to implement WHO treatment improvements seems to need the courage of legislators to follow OHCHR suggestions and a shift of paradigm.
Article Details
How to Cite
KEIM, Walter.
Paradigm Shift to Promote a Revolution of Treatment of Schizophrenia to Achieve Recovery.
Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4866>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i12.4866.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. N R Schooler, S C Goldberg, H Boothe, J O Cole. One year after discharge: community adjustment of schizophrenic patients. Am J Psychiatry. 1967 Feb;123(8):986-95. doi: 10.1176/ajp.123.8.986.
4. M Rappaport, H K Hopkins, K Hall, T Belleza, J Silverman. Are there schizophrenics for whom drugs may be unnecessary or contraindicated? Int Pharmacopsychiatry. 1978;13(2):100-11. doi: 10.1159/000468327.
5. Whitaker R: The Case Against Antipsychotics: A Review of Their Long-Term Side Effects. Cambridge,Mass, Mad in America Foundation, 2016 https://www.madinamerica.com/2016/07/the-case-against-antipsychotics/
6. Leucht, S., Arbter, D., Engel, R. et al. How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials. Mol Psychiatry 14, 429–447 (2009). https://doi.org/10.1038/sj.mp.4002136
7. Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev. 2012 May 16;(5):CD008016. doi: 10.1002/14651858.CD008016.pub2
8. Leucht S, Leucht C, Huhn M, Chaimani A, Mavridis D, Helfer B, Samara M, Rabaioli M, Bächer S, Cipriani A, Geddes JR, Salanti G, Davis JM. Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors. Am J Psychiatry. 2017 Oct 1;174(10):927-942. doi: 10.1176/appi.ajp.2017.16121358. Epub 2017 May 25. PMID: 28541090.
9. Robert Whitaker. The case against antipsychotic drugs: a 50-year record of doing more harm than good. Medical Hypotheses Volume 62, Issue 1, January 2004, Pages 5-13. https://doi.org/10.1016/S0306-9877(03)00293-7
10. Whitaker R: The Case Against Antipsychotics: A Review of Their Long-Term Side Effects. Cambridge, Mass, Mad in America Foundation, 2016 https://www.madinamerica.com/2016/07/the-case-against-antipsychotics/
11. Sohler N, Adams BG, Barnes DM, Cohen GH, Prins SJ, Schwartz S. Weighing the evidence for harm from long-term treatment with antipsychotic medications: A systematic review. Am J Orthopsychiatry. 2016;86(5):477-485. doi:10.1037/ort0000106
12. Robert Whitaker. The Case Against Antipsychotics. online publication July 25, 2016. https://www.madinamerica.com/2016/07/the-case-against-antipsychotics/
13. Dalsbø TK, Dahm, KT, Øvernes, LA, Lauritzen M, Skjelbakken T. [Effectiveness of treatment for psychosis: evidence base for a shared decision-making tool] Rapport 2019. Oslo: Folkehelseinstituttet, [Norwegian Institute of Public Health ] 2019.
14. Iversen TSJ, Steen NE, Dieset I, et al. Side effect burden of antipsychotic drugs in real life - Impact of gender and polypharmacy. Prog Neuropsychopharmacol Biol Psychiatry. 2018;82:263-271. doi:10.1016/j.pnpbp.2017.11.004 Nov 7. PMID: 29122637.
15. Lindström E, Lewander T, Malm U, Malt UF, Lublin H, Ahlfors UG. Patient-rated versus clinician-rated side effects of drug treatment in schizophrenia. Clinical validation of a self-rating version of the UKU Side Effect Rating Scale (UKU-SERS-Pat). Nord J Psychiatry. 2001;55 Suppl 44:5-69. doi:10.1080/080394801317084428
16. Danborg PB, Gøtzsche PC. Benefits and harms of antipsychotic drugs in drug-naïve patients with psychosis: A systematic review. Int J Risk Saf Med. 2019;30(4):193-201. doi:10.3233/JRS-195063
17. Gøtzsche PC. Forced Drugging with Antipsychotics is Against the Law: Decision in Norway online publication Cambridge, Mass, Mad in America Foundation, 2016. https://www.madinamerica.com/2019/05/forced-drugging-antipsychotics-against-law/
18. Zinkler, M. Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience. March 2016 Laws 5(1):15. DOI: 10.3390/laws5010015
19. Flammer E, Steinert T. [The Case Register for Coercive Measures According to the Law on Assistance for Persons with Mental Diseases of Baden-Wuerttemberg: Conception and First Evaluation]. Psychiatr Prax. 2019;46(2):82-89. doi:10.1055/a-0665-6728
20. Sanne Koops, Kelly Allott, Lieuwe de Haan, Eric Chen, Christy Hui, Eoin Killackey, Maria Long, Joanna Moncrieff, Iris Sommer, Anne Emilie Stürup, Lex Wunderink, Marieke Begemann, TAPER international research consortium, Addressing the Evidence to Practice Gap: What to Expect From International Antipsychotic Dose Reduction Studies in the Tapering Anti-Psychotics and Evaluating Recovery Consortium, Schizophrenia Bulletin, 2023;, sbad112, https://doi.org/10.1093/schbul/sbad112
21. Begemann MJH, Thompson IA, Veling W, et al. To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial. Trials. 2020;21(1):147. Published 2020 Feb 7. doi:10.1186/s13063-019-3822-5
22. Kudlow P. The perils of diagnostic inflation. CMAJ. 2013;185(1):E25-E26. doi:10.1503/cmaj.109-4371
23. Hyman SE. The Diagnosis of Mental Disorders: The Problem of Reification. Annual Review of Clinical Psychology. Vol. 6:155-179 (Volume publication date 27 April 2010). https://doi.org/10.1146/annurev.clinpsy.3.022806.091532
24. Insel, T. Post by Former NIMH Director Thomas Insel: Transforming Diagnosis. NMIH website 2013. https://web.archive.org/web/20210509074446/https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis
25. Aarre TF. A farewell to psychiatric diagnoses. Tidsskr Nor Legeforen 2022. doi: 10.4045/tidsskr.22.0386
26. Johannessen JO, Joa I. Modern understanding of psychosis: from brain disease to stress disorder. And some other important aspects of psychosis. Psychological, Social and Integrative Approaches Volume 13, 2021 - Issue 4 doi: 10.1080/17522439.2021.1985162
27. WHO. Mental health action plan 2013 – 2020 online publication 6 January 2013. https://www.who.int/publications/i/item/9789241506021
28. Funk M, Bold ND. WHO's QualityRights Initiative: Transforming Services and Promoting Rights in Mental Health. Health Hum Rights. 2020;22(1):69-75.
29. Robert W. Buchanan, Julie Kreyenbuhl, Deanna L. Kelly, Jason M. Noel, Douglas L. Boggs, Bernard A. Fischer, Seth Himelhoch, Beverly Fang, Eunice Peterson, Patrick R. Aquino, William Keller, The 2009 Schizophrenia PORT Psychopharmacological Treatment Recommendations and Summary Statements, Schizophrenia Bulletin, Volume 36, Issue 1, January 2010, Pages 71–93, https://doi.org/10.1093/schbul/sbp116
30. Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev. 2012 May 16;(5):CD008016. doi: 10.1002/14651858.CD008016.pub2
31. Anna Ceraso, Jessie Jingxia Lin, Johannes Schneider-Thoma, Spyridon Siafis, Stephan Heres, Werner Kissling, John M Davis, Stefan Leucht, Maintenance Treatment With Antipsychotic Drugs in Schizophrenia: A Cochrane Systematic Review and Meta-analysis, Schizophrenia Bulletin, Volume 48, Issue 4, July 2022, Pages 738–740, https://doi.org/10.1093/schbul/sbac041
32. Jääskeläinen E, Juola P, Hirvonen N, et al. A systematic review and meta-analysis of recovery in schizophrenia. Schizophr Bull. 2013;39(6):1296-1306. doi:10.1093/schbul/sbs130
33. Harrow M, Jobe TH. Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. J Nerv Ment Dis. 2007;195(5):406-414. doi:10.1097/01.nmd.0000253783.32338.6e
34. Wunderink L, Nieboer RM, Wiersma D, Sytema S, Nienhuis FJ. 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. 2013;70(9):913–920. doi:10.1001/jamapsychiatry.2013.19
35. Martin Harrow, Thomas H. Jobe, Robert N. Faull, Jie Yang. A 20-Year multi-followup longitudinal study assessing whether antipsychotic medications contribute to work functioning in schizophrenia. Psychiatry Research, Volume 256, 2017, Pages 267-274. ISSN 0165-1781. https://doi.org/10.1016/j.psychres.2017.06.069
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