May 23, 2007

Schizophrenia Treatment Goal Can Go Beyond Simple Maintenance

Some doctors are saying that although there is not yet a "cure" for schizophrenia, "remission" or "recovery" are valid treatment goals.

The idea that the prognosis (predicted outcome) for all people with schizophrenia is universally poor is being increasingly challenged. Criteria for "remission" have been developed to which improvements in pharmacologic, psychosocial, and psychotherapeutic treatments can be measured against.

One article in Schizophrenia Source reports on findings from researchers looking at some naturalistic data for people with schizophrenia or schizoaffective disorder using the remission criteria. The remission criteria is based on having low severity of symptoms that is sustained over a period of at least 6 months. The symptoms assessed include delusions, unusual thought content, hallucinatory behavior, conceptual disorganization, mannerisms/posturing, blunted affect, social withdrawal, and lack of spontaneity.

The researchers noted that by the study's end, 29% of the patients met the criteria for remission, with better illness-related insight and better overall functioning. The researchers concluded that

"The remission severity and time criteria appear to combine into a valid concept for daily clinical practice and should be a target for treatment."

In another article, located on MedPage Today, doctors discuss the same topic, reaching the same conclusion - that remission/recovery is a valid taget to aim for when treating schizophrenia. That article includes a discussion tackling the issue of switching medications in an attempt to reach that goal, as well as the idea that more than just medication may be needed.

The doctors incorporate into their discussion, the results from CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) schizophrenia study studies showing that 1 - First-generation antipsychotics are as effective as second-generation antipsychotics, and 2- Switching antipsychotics is risky as demonstrated by a study of moderately ill patients showing that those were randomized to stay on their current treatment did better than those who switched.

Dr. Peter J. Weiden, M.D., of the University of Illinois at Chicago, said that some studies show that it is possible for some people to see modest but continued improvement over time with some atypical antipsychotics. He goes on to say,

"This means that the recovery model is feasible from a psychopharmacology standpoint. It may be slow, it may not happen to everyone, but it is proof of concept."
The discussion goes on to say that side-effects such as extrapyramidal symptoms, weight gain, sedation, elevated triglyceride and cholesterol levels, insulin resistence and other metabolic disorders are not entirely unavoidable or necessary long-term side-effects. Dr. Weiden commented that,
"Unlike efficacy switches, the side effect differences after switching are very predictable, And many of the short-term side effect benefits may go on to provide greater relief over time."
Addressing the CATIE study about switching antipsychotics, Dr. Rajiv Tandon, M.D., of the University of Florida in Gainesville warned that the results show that switching antipsychotics can be risky, but he added that if a switch is decided upon, it should be done gradually with careful monitoring, and that the new antipsychotic should be quite different from the medication being switched from, and carefully selected based on the reason for the switch.

Echoing conclusions expressed in other articles, that therapy should be tailored to the individual, and that more than pharmacological treatment is often warranted, Dr. Tandon expressed the idea that other types of treatment for schizophrenia, including cognitive behavior therapy, rehabilitation therapies, and community services geared towards helping with employment and housing approaches such as providing employment or housing support, may be effective additions to helping patients regain function as well.

Read the articles: Remission 'valid concept' in schizophrenia, should be therapy target
Original Source: Journal Schizophrenia Research 2007; 92: 68–73
Schizophrenia Treatment Reaches Toward Recovery

Related Reading:
Remission in Early Psychosis: A Study
Schizophrenia Society of Canada Emphasizes Quality Of Life
Schizophrenia Drug Studies: One Size Does Not Fit All; Community Services Also Needed
Medication is Not Enough: Job and Family Counseling Needed as Well
Patients May Try Many Medications Before Finding One That Helps
Tailored Treatment of Schizophrenia


my son is on leponex for 3 years, now the main problem is weight gain. He doesn't want to take leponex for the weight gain. Medication is changed from leponex to haldol yesterday. Is there any suggestion on that?

Posted by: ilker at May 24, 2007 12:32 AM

Ilker, for comments and suggestions on the topic of Haldol, enter this post on one of the Community Discussion Boards, such as the one for "Medications" in the Main Discussion Area.

Click here for information on ==> Common Traditional Medications for Schizophrenia

Posted by: Jeanie at May 24, 2007 11:02 AM

I support the view that "remission" or "recovery" is valid treatment goals. My own experience of dealing with my wife's sz strongly suggests that some schizophrenics can live a close to normal life with good family support and understanding of sz.

Posted by: JD05 at May 24, 2007 04:50 PM

I believe that recovery is not only possible, but that recovery is a human right of everyone who has schizophrenia , or any other mental illness. Recovery can be defined as the abililty for the person with the illness to lead a meaningful life, in a community of his or her choosing , while striving to fulfill his or her potential. It is not a linear process, and one person's recovery does not necessarily look like the next persons. I have surprised myself by how much I have been able to recover so far. And my life just keeps getting better! I used to think I was going to be going in and out of the hospital forever.
I have not been to the hospital in more than eight years now.The quality of my life is very good.
Part of this is due to an atypical antipsychotic.
That is only part of the story.
I work very hard to maintain a vibrant recovery.
It is worth it!!!!!I am so grateful for my recovery
and now work to help make it possible for others who are struggling.

Posted by: meghan caughey at May 26, 2007 07:54 AM

Wow. I am touched by what Meghan wrote. Truly what it is all about : being positive & optimistic & embracing & celebrating yourself & others. Of course ones doctors must support & share this attitude also. If not then I suggest changing your doctor. Thank God gone are the days when the mentally ill are not expected to have a nice life let alone a useful and happy one. I thank Meghan for her post and hope others share the viewpoint.

Posted by: Frank S at May 26, 2007 03:18 PM

My son has schizophrenia and is living proof that you can recover. The process takes about five years and begins with the proper medication. I took over his care and taught him about the disease and the medication. He takes zyprexa for disorganized schizophrenia and has a regular exercise program, watches his diet and has not gained an ounce. At times he has actually lost. He gave up smoking when he was sick. I then put him through my re-hab program which included a return to university and constant tutoring. He continually got better as I made sure there was no "idle" time, I constantly challenged his brain and retrained him. I got him back into society and then after graduation looked into work. That did not go as well as we hoped, he needed skills yet the attempts and interviews as well as work related programs like the Built Network were very helpful in buliding confidence and I used as many as I could find.He then returned to NSCC in business and this time without a tutor.The hard work at re-hab had paid off he was now flying on his own. He did honors work this year with 100% in accounting. He is back in the program this fall to complete an accounting concentration and then a full time job may result. He did work full time this summer for the Federal Government.He actually was interviewed for three jobs and got them all. He took the one that best suited his program.It was a journey filled with stigma and many many barriers and roadblocks. You have to fight for everything but it is sure worth every battle to win the war. It can be done, just do not let anyone tell you that it is hopeless and not to expect too much.

Posted by: Cecilia M at July 27, 2007 05:08 AM

My daughter was admitted to psych ward on 4/04 and stayed there for 13 days. She experienced classic psychosis which were finally subdued by Zyprexa and other meds. The Dr. did not diagnose her with sz. Within days of release from hospital, she had relapse and we took her to psychiatrist - different from one in hospital. This dr. changed her meds and increased dosage which had many unplesant side effects for her - this Dr. then told me in private that she believed my daughter had sz - that she was 90% sure of this and not to tell my wife or daughter this. Well you know how these dr.'s words can affect us! My daugther (20 at the time) finally asked to be "taken off" the meds - this was done slowly and completed by end of may of 04. She continued to sleep in our room at night for another 4 months, and finally returned to college and her own room in sep 04. She has since then had no symptoms whatso ever... naturally I still wonder if she really has sz and if it just went dormant. God willing, she will continue to have a normal, happy healthy life. I hope others might benefit from this - don't be afraid to suggest getting off the meds as they can sometimes be the sole cause of the problem.. I will probably never know what really happened and the uncertaintly of these two psychiatric drs underlies how little is known about the mind and the brain.

Posted by: starbros at September 29, 2007 11:58 AM

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