January 01, 2006

30% stop meds due to poor response

One Third Of Patients Who Stop Treatment For Schizophrenia Early Do So Due To Poor Response

A third of patients treated for schizophrenia who stop taking their medication early do so because they do not feel any significant improvement or because their symptoms are worsening. A study published today in the open access journal BMC Medicine reveals that patients with schizophrenia are three times more likely to stop treatment because of poor response or worsening symptoms, than because of adverse non-psychiatric side effects.

Hong Liu-Seifert and colleagues from Eli Lilly and Company in Indianapolis, USA, analysed the reasons for stopping treatment of patients who took part in four previous Eli Lilly studies. The studies included a total of 1627 patients and compared the effects of taking olanzapine, risperidone, quetiapine or ziprasidone in patients diagnosed with schizophrenia or related disorders.

Liu-Seifert et al.'s analysis shows that 53% (866/1627) of patients stopped treatment early. Of the 866 patients who stopped treatment, 36% (315/866) did so because the treatment was felt not to be effective or because their symptoms worsened. Only 12% of patients who stopped treatment early did so because of adverse events such as dizziness, fatigue, vomiting or weight gain.

Of the 315 patients who stopped because of poor response to treatment, 80% stopped because they themselves believed it wasn't effective. Only 20% of the patients studied stopped taking medication based on a doctor's decision that the treatment wasn't effective.

"Discontinuation due to patient perception of poor response appeared to occur particularly early in the course of treatment," the authors write. Liu-Seifert et al. found that patients who experienced an early response to medication were 80% more likely to complete treatment.

The authors' findings suggest that early and effective symptom control, and discussing expectations of treatment, may help to ensure that people suffering from schizophrenia continue to take their medication.

Source: Discontinuation of treatment of schizophrenic patients is driven by poor symptom response: a pooled post-hoc analysis of four atypical antipsychotic drugs
Hong Liu-Seifert, David H Adams and Bruce J Kinon
BMC Medicine 2005, 3:21 (23 December 2005)


a great many people i work with stop medication stating 'it is not working' despite observable, large and beneficial changes in their daily activities, cognition, sentence structure and ability to cope independently.

since schizophrenia affects a person's ability to evaluate their own behavior and to detect neurological changes in their perception, cognition and function, and since nearly all neurological/"mental illnesses" involve a loss of insight (it is common for depressed people to have no idea they are depressed, and for bipolars to ask "how do i know i'm manic?" and for people with even more "physical" neurological conditions to have no idea what they are perceiving is "symptoms", that it really is almost unthinkable that such a study would be measuring actual response to medication), the study is far more likely to be measuring the degree to which insight affects compliance than the above summary would suggest.

people very often do not have any ability to determine when the medication is causing a reduction of symptoms or increase in ability to cope, that is somewhat expected as they usually can't tell they are ill in the first place. schizophrenia affects perception in such a way that it does not seem that one is ill. the brain can not tell you when the brain is sick. there is a lack of 'insight' about 'insight' from the medical community expressed in this summary. those who conducted the study may not be so misled, but this summary certainly is.

it would be more accurate to state that 'many stop medication because they don't perceive an improvement', than to say that there is no improvement. people who don't want to take medication and have been forced into it while paranoid and lacking in insight generally are able to provide very compelling reasons for not taking medication that are designed to appeal to people emotionally, often they don't like how they feel while taking it. many like their symptoms - psychosis and paranoia can create in a person a very strong desire to remain untreated.


Posted by: slc at January 17, 2006 08:30 AM

I think in most every case it is the patient's won reporting of symptoms that decides the DX and the treatment.

If the patients judgement is in question..well everything goes out the window.

Also,if a person seeks medication and takes medication and finds it is not working and you call the persons judgement into question that should be absolute proof the medication did nothing to improve the person's judgement. Case Closed.

Posted by: symptomatic at July 16, 2006 02:23 PM

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