Post by Admin on Apr 8, 2024 15:41:16 GMT
Witless and Dangerous? – Challenging some assumptions of the ‘schizo’ paradigm
By Neil Broatch -08/04/2024
www.madintheuk.com/2024/04/witless-and-dangerous-challenging-some-assumptions-of-the-schizo-paradigm/
In Part 1, I looked at some evidence on ‘disappointing’ long-term outcomes for early intervention in psychosis (EIP) recipients, and also some findings on ‘functional outcomes’ between drug discontinuation and maintenance treatment cohorts. I attributed these trends chiefly to the inefficacy of neuroleptics over the long-term.
I hope my discussion can contribute a little to advancing understanding of how a drug based ‘disease model’ of mental distress can often do more harm than good. The growing awareness of which owes much to Robert Whitaker’s ground-breaking work in Anatomy of an Epidemic. For a summary of the book’s arguments read this.
Here, I start by looking at some objections to ‘deprescribing’.’ I consider them as revealing the incoherence of certain assumptions behind early intervention, and indeed, of psychiatric diagnosis more widely.
When responding to the case that patients seem over the longer term, to have better social and occupational (functional) outcomes off standard maintenance treatment (MT), many psychiatrists will object that the risks of relapse after drug discontinuation are too great. Indeed, the dangers of withdrawal should not be taken lightly. ‘Relapses’ can have disruptive and serious consequences.
Nevertheless, most of the objections do not take into account the drug withdrawal induced ‘rebound’ effects I discussed in Part 1. The real nature of such symptoms is generally overlooked (and misdiagnosed), along with their potential avoidabililty. Obviously, it is imperative to minimise risks of relapse, but not at the cost of the reduced life expectancy associated with long-term use of neuroleptics.
There is a clear need for services and patients to work with more appropriate tapering regimens to enable those with remitted psychosis to reduce the drugs’ toll on their systems. Employing more gradual (‘hyperbolic’) tapers, the risks of withdrawal can be minimised and managed. The guidance which follows from this understanding can actually be considered more cautious than current standard clinical practice. For instance, when switching drugs, as well as in the protocols of pharma sponsored trials on antipsychotic efficacy. Where often four weeks or less are scheduled for drug discontinuation.
The idea of gradual tapering — with progressively smaller dose reduction increments over an extended taper period, giving the brain time to adapt — was understood informally by some in the mental health recovery community, notably Will Hall, even if it wasn’t generally recognised by prescribers, much less the majority of those who had to live with the drugs.
This kind of approach has now been given a more formal, scientific underpinning based on the ‘hyperbolic’ relation between dose level and dopamine receptor occupancy.
rest in link
By Neil Broatch -08/04/2024
www.madintheuk.com/2024/04/witless-and-dangerous-challenging-some-assumptions-of-the-schizo-paradigm/
In Part 1, I looked at some evidence on ‘disappointing’ long-term outcomes for early intervention in psychosis (EIP) recipients, and also some findings on ‘functional outcomes’ between drug discontinuation and maintenance treatment cohorts. I attributed these trends chiefly to the inefficacy of neuroleptics over the long-term.
I hope my discussion can contribute a little to advancing understanding of how a drug based ‘disease model’ of mental distress can often do more harm than good. The growing awareness of which owes much to Robert Whitaker’s ground-breaking work in Anatomy of an Epidemic. For a summary of the book’s arguments read this.
Here, I start by looking at some objections to ‘deprescribing’.’ I consider them as revealing the incoherence of certain assumptions behind early intervention, and indeed, of psychiatric diagnosis more widely.
When responding to the case that patients seem over the longer term, to have better social and occupational (functional) outcomes off standard maintenance treatment (MT), many psychiatrists will object that the risks of relapse after drug discontinuation are too great. Indeed, the dangers of withdrawal should not be taken lightly. ‘Relapses’ can have disruptive and serious consequences.
Nevertheless, most of the objections do not take into account the drug withdrawal induced ‘rebound’ effects I discussed in Part 1. The real nature of such symptoms is generally overlooked (and misdiagnosed), along with their potential avoidabililty. Obviously, it is imperative to minimise risks of relapse, but not at the cost of the reduced life expectancy associated with long-term use of neuroleptics.
There is a clear need for services and patients to work with more appropriate tapering regimens to enable those with remitted psychosis to reduce the drugs’ toll on their systems. Employing more gradual (‘hyperbolic’) tapers, the risks of withdrawal can be minimised and managed. The guidance which follows from this understanding can actually be considered more cautious than current standard clinical practice. For instance, when switching drugs, as well as in the protocols of pharma sponsored trials on antipsychotic efficacy. Where often four weeks or less are scheduled for drug discontinuation.
The idea of gradual tapering — with progressively smaller dose reduction increments over an extended taper period, giving the brain time to adapt — was understood informally by some in the mental health recovery community, notably Will Hall, even if it wasn’t generally recognised by prescribers, much less the majority of those who had to live with the drugs.
This kind of approach has now been given a more formal, scientific underpinning based on the ‘hyperbolic’ relation between dose level and dopamine receptor occupancy.
rest in link