Post by Admin on Apr 8, 2024 12:07:38 GMT
From the Dopamine Theory to the Outcomes Paradox
By Neil Broatch -April 6, 2024
www.madinamerica.com/2024/04/from-the-dopamine-theory-to-the-outcomes-paradox/
This is intended as the first part of a look at pathways and outcomes in ‘psychosis’ and ‘schizophrenia’. Here, I discuss some of what’s not right in the picture for the current paradigm; an approach which, in essence, dates from the 1950s.
By way of introduction, let’s consider a finding from decades ago. In a previous piece on how psychiatric drugs can often tend to make things worse, I referred to a series of WHO investigations (see this pdf). These found better recovery rates from psychosis in lower income countries, compared with their richer counterparts. Known as the ‘outcomes paradox’ or as the ‘better prognosis hypothesis’, it has been considered a well established feature of the global epidemiology of ‘schizophrenia’. ‘Paradoxical’, because in contrast with healthcare outcomes generally being better in ‘developed’ (high income) countries, outcomes for those who had suffered psychosis were apparently better in the ‘developing’, lower and middle income countries.
…course and outcome for subjects in the developing centers were more favorable than for their developed world counterparts… even for subjects whose early course was poor, the likelihood of later recovery favors those in the developing centers…
At the time, the findings were attributed by researchers largely to cultural factors. Perhaps it was better social inclusion of sufferers that enabled recovery.
Subsequently, the picture was challenged. Critics dismissed the better prognosis hypothesis, pointing to contrary findings like much reduced life expectancy for those diagnosed compared with the general population in lower income countries. They argued that the supposedly more favourable sociocultural context in ‘developing’ countries, is often not to be found. There is, after all, plenty of stigma against those experiencing mental ill-health in both richer and poorer societies.
As trends of urbanization and migration gained pace in the ‘developing world’, some pointed to factors like these as much increasing a person’s risk of experiencing psychosis. So perhaps greater urbanization in the industrialized countries, as opposed to more rural living in the ‘third world’ was part of the explanation for the trend.
But to my mind there seems to be a neglected factor that could help explain the trend: different levels of the use of so called ‘antipsychotic’ drugs. As far as I’m aware, this has not generally been much considered in the literature on the outcomes paradox, with few exceptions.
By Neil Broatch -April 6, 2024
www.madinamerica.com/2024/04/from-the-dopamine-theory-to-the-outcomes-paradox/
This is intended as the first part of a look at pathways and outcomes in ‘psychosis’ and ‘schizophrenia’. Here, I discuss some of what’s not right in the picture for the current paradigm; an approach which, in essence, dates from the 1950s.
By way of introduction, let’s consider a finding from decades ago. In a previous piece on how psychiatric drugs can often tend to make things worse, I referred to a series of WHO investigations (see this pdf). These found better recovery rates from psychosis in lower income countries, compared with their richer counterparts. Known as the ‘outcomes paradox’ or as the ‘better prognosis hypothesis’, it has been considered a well established feature of the global epidemiology of ‘schizophrenia’. ‘Paradoxical’, because in contrast with healthcare outcomes generally being better in ‘developed’ (high income) countries, outcomes for those who had suffered psychosis were apparently better in the ‘developing’, lower and middle income countries.
…course and outcome for subjects in the developing centers were more favorable than for their developed world counterparts… even for subjects whose early course was poor, the likelihood of later recovery favors those in the developing centers…
At the time, the findings were attributed by researchers largely to cultural factors. Perhaps it was better social inclusion of sufferers that enabled recovery.
Subsequently, the picture was challenged. Critics dismissed the better prognosis hypothesis, pointing to contrary findings like much reduced life expectancy for those diagnosed compared with the general population in lower income countries. They argued that the supposedly more favourable sociocultural context in ‘developing’ countries, is often not to be found. There is, after all, plenty of stigma against those experiencing mental ill-health in both richer and poorer societies.
As trends of urbanization and migration gained pace in the ‘developing world’, some pointed to factors like these as much increasing a person’s risk of experiencing psychosis. So perhaps greater urbanization in the industrialized countries, as opposed to more rural living in the ‘third world’ was part of the explanation for the trend.
But to my mind there seems to be a neglected factor that could help explain the trend: different levels of the use of so called ‘antipsychotic’ drugs. As far as I’m aware, this has not generally been much considered in the literature on the outcomes paradox, with few exceptions.