Mental Disease treated with anti psychotic drugs do not always help

March 3, 2018 7:57 AM

“don’t take my devils away, because my angels may flee, too.” Being an active part of a community, I believe, could be helpful for many ails though it’s important for those with schizophrenia.
posted by Yellow (4 comments total)

Excellent article, I really liked it. The distinction between rates of diagnosis between individualist and collectivist cultures is interesting:

In Han’s study, the average TPJ activity levels of people from the traditionally interdependent country looked closer to those of schizophrenic patients. Other studies, including Chiyoko Kubayashi Frank at the School of Psychology at Fielding Graduate University in Santa Barbara, have theorized that diminished activity in the TPJ area in Japanese adults and children during theory of mind tasks “might represent the demoted sense of self-other distinction in the Japanese culture.”

Which makes me wonder if the gender differences in the developed world are also related to women being socialised to have a less individual sense of self?
posted by saucysault at 9:54 AM on March 3, 2018 [3 favorites]

The pathology is universal (but can be influenced by socioenvironment). Disease is the organic process, illness is the cultural expression of the reaction to the disease. However, we work with the culture we have, with the people embedded in it as they are. I'm a doctor, so I'm positively biased in terms of intervention. Especially in some higher SES cultures in the U.S. that tend to have more antivaxxers and suchlike, I can explain some of the risks of undertreatment but this is sometimes perceived as unwelcome. For example, a 1,000% in the risk of relapse of psychosis if first-episodes psychosis treatment is interrupted. Many people get it, but some do not. I like to try to give people the option to stay alive and healthy as long as they are not suffering too much.

Five-fold increased risk of relapse following breaks in antipsychotic treatment of first episode psychosis

Risk of symptom recurrence with medication discontinuation in first-episode psychosis: A systematic review

Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis

Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia

Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis

Wrt the idea that the widespread (ie, the vast pattern linkages seen in genome-wide studies) genetic damage seen in psychotic/affective disorders is linked to an adaptive vulnerability for onset of the symptoms seen in illnesses such as schizophrenia, schizoaffective, autism, etc. and this vulnerability is somehow conserved because it confers some sort of evolutionary or language/cognitive advantage, well, I am unconvinced, but there have been a lot of papers on it.

Schizotypy and language: A review

Is schizophrenia “the price that Homo sapiens pays for language”? Subcortical language processing as the missing link between evolution and language disorder in psychosis – A neurolinguistic approach


The genetic basis of thought disorder and language and communication disturbances in schizophrenia


The nuclear symptoms of schizophrenia reveal the four quadrant structure of language and its deictic frame

Semantic processing and thought disorder in childhood-onset schizophrenia: Insights from fMRI
posted by meehawl at 1:26 PM on March 3, 2018 [12 favorites]

Meehawl do you know if the studies you listed accounted for the potential for withdrawal from antipsychotics themselves to be a factor in heightened risk of mental illness episodes after ceasing taking them? All the studies you mentioned are two years or less that seem to indicate increased risk of episodes, however the ten year demonstrated a substantial number of people off of antipsychotics and stable.

Is it possible people who take them are having to heal both from their trauma and difficulties AND from the drugs given to them? In America almost no one manages to get diagnosed without being given the drugs at first episode (if hospitalized) so how would one do a study on how people who were never given them did over a one or two year span? I worry there's an inherent bias in the system that makes testing for different ways of handling mental health very difficult to test for.

I'm hoping that programs that offer medication free treatment will do long term studies and keep track of outcomes because that will help us tease out what the truths vs biases are.
posted by xarnop at 5:35 PM on March 3, 2018 [2 favorites]

the ten year demonstrated a substantial number of people off of antipsychotics and stable.

Measurements of cohorts are difficult because there's a survivor bias, and a selection bias. They are also fantastically difficult to continue because people move around a lot. It's great that a small number of people can manage without medication to address their symptoms. But most can't without experiencing symptom exacebation. If I took a cohort of people with severe hypertension, after 10 years off meds some would be devoid of measurable pathology, because people are weird like that. But the majority would show some damage, to their kidneys, their brains, their hearts, etc. For "schizophrenia", how many people in this small number were mis-diagnosed? How many have unusual genetics? How many are a zebra like Stephen Hawking, with an "ALS" that for some reason stopped progressing? Also consider the social determinants of health. People who have more family/wealth support or are less sick will tend to to get less meds and more services. Especially for schizophrenia, some of the sickest people will be dead (most likely by suicide) after ten years and not counted in the survivor cohort.

Some of the longest outcomes studies with reasonable power (ie, a meaningful number of participants) have been done on a Finnish cohort. Given current funding, it's virtually impossible within the fractured US health system to do meaningfully large-scale, long-term behavioral health studies, which is why most of the good research comes from outside the US. Mortality is one of the easier outcomes to measure.

Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study

Compared with no exposure, both moderate (adjusted hazard ratio=0.59, 95% CI=0.49–0.70) and high (adjusted hazard ratio=0.75, 95% CI=0.63–0.89) antipsychotic exposures were associated with substantially lower overall mortality. Moderate antidepressant exposure was associated with a lower mortality (adjusted hazard ratio=0.85, 95% CI=0.73–0.98), and high exposure, even lower (adjusted hazard ratio=0.71, 95% CI=0.59–0.86). Exposure to benzodiazepines showed a dose-response relationship with mortality (hazard ratios up to 1.74 [95% CI=1.50–2.03]).

(This is why many psychiatrists are cautious concerning non-acute benzo use)
posted by meehawl at 7:23 PM on March 3, 2018 [6 favorites]