David Baxter PhD
Late Founder
Drugs not enough for schizophrenia
The News & Observer, Raleigh, N.C. - March 01, 2007
The latest findings from a landmark mental health study involving researchers at UNC-Chapel Hill and Duke University continue to challenge the notion that people with schizophrenia and other severe mental illnesses can get better with medication alone, even when they take the newest antipsychotic drugs.
A study led by Dr. T. Scott Stroup, a psychiatrist at UNC-CH's School of Medicine, found that nearly 70 percent of patients taking one of three newer schizophrenia medicines -- all thought to have milder side effects than older drugs -- quit taking the pills. They stopped in part because the medicine did not control symptoms or caused side effects such as weight gain and agitation.
Schizophrenia is a brain disorder that causes hallucinations, delusions and other psychotic symptoms. It strikes about 1.1 percent of adults or 2.4 million Americans 18 and older, according to the National Institute of Mental Health.
A second study led by Duke University psychiatrist Dr. Marvin Swartz found that only about a third of patients with schizophrenia reported improvements in their quality of life when they stayed on their medicines. Even then, the gains were modest. He concluded that successful drug therapy must be accompanied by intensive support, including family counseling, vocational training and regular contact with doctors and other professionals.
Both studies are published in the March issue of the American Journal of Psychiatry.
"Increasingly, the only treatment folks with schizophrenia get is drug therapy," Swartz said. "The hope is that there's going to be a silver bullet and, increasingly, the evidence is that there isn't one."
That revelation might echo particularly loudly in North Carolina, where the state is poised to begin shutting down Dorothea Dix Hospital in Raleigh by the end of the year as part of an effort to keep people with major mental illness out of institutions. Instead, the goal is to treat patients in communities where they live. Most parts of the state, however, still lack the types of services that psychiatrists and mental health advocates say are needed.
"It highlights some of the challenges of mental health reform," Swartz said of his study. "Medicines can ameliorate symptoms, but achieving functional gains that allow you to live, work and get along with people takes other kinds of therapy that are in short supply in North Carolina."
The two schizophrenia studies are the latest results from the $42.6 million Clinical Antipsychotic Trials of Intervention Effectiveness or CATIE project, a massive project launched in 2001 by the National Institute of Mental Health to study mental health drugs. Duke, UNC-CH, Dorothea Dix and other state mental hospitals all participated as study sites.
Initial results published in September 2005 created a stir by reporting that newer and more costly schizophrenia drugs such as Eli Lilly's Zyprexa and AstraZeneca's Seroquel did not work much better than older, cheaper pills. And one older medicine, perphenazine -- which had often been cast aside in favor of newer treatments -- was shown to work as well as all but one of the latest drugs.
The findings surprised psychiatrists, many of whom had thought that the newer medicines would come out on top.
That is hardly news to Ann Akland of Knightdale, whose adult daughter has schizo-affective disorder, a combination of hallucination, delusions and depressive symptoms. Akland is also president of the Wake County chapter of the National Alliance for the Mentally Ill.
She said her daughter, Kristen, started and stopped about five medicines before finding Clozaril about 10 years ago. It was one of the first "next generation" anti-psychotics introduced. As newer drugs came on the market, Akland's daughter, now 27, tried those, but always went back to Clozaril.
"It was the only thing that worked for her," Akland said. Even with medicine, however, Akland said her daughter still has psychotic episodes and needs extensive support to live in the community.
Stroup, the UNC-Chapel Hill psychiatrist, said that the CATIE results have produced valuable clinical information. Psychiatrists now have better information about the specific side effects associated with each of the drugs. They also have more data on which drugs patients fared well on after failing on other medicines.
"It may help people get more effective treatment sooner," Stroup said.
Nonetheless, Stroup said some of his colleagues were disappointed that 68 percent of the 114 patients in the latest drug study stopped taking their medicines. The three newer drugs tested -- Zyprexa, Seroquel and Risperdal -- all had been thought to have less severe side effects than older drugs.
Dr. Brian Sheitman, chief of adult psychiatry at Dorothea Dix and the hospital's associate director for clinical research, said it is typical for people with schizophrenia and other psychotic symptoms to quit taking their medicines. A lot of the time, he said, patients don't recognize they have an illness.
"They don't see the benefits, they don't like the side effects and if they skip a couple of doses they feel better -- it's really not surprising that they stop taking their medicines," Sheitman said. "Unfortunately, these are patients we really don't have good answers for."
The News & Observer, Raleigh, N.C. - March 01, 2007
The latest findings from a landmark mental health study involving researchers at UNC-Chapel Hill and Duke University continue to challenge the notion that people with schizophrenia and other severe mental illnesses can get better with medication alone, even when they take the newest antipsychotic drugs.
A study led by Dr. T. Scott Stroup, a psychiatrist at UNC-CH's School of Medicine, found that nearly 70 percent of patients taking one of three newer schizophrenia medicines -- all thought to have milder side effects than older drugs -- quit taking the pills. They stopped in part because the medicine did not control symptoms or caused side effects such as weight gain and agitation.
Schizophrenia is a brain disorder that causes hallucinations, delusions and other psychotic symptoms. It strikes about 1.1 percent of adults or 2.4 million Americans 18 and older, according to the National Institute of Mental Health.
A second study led by Duke University psychiatrist Dr. Marvin Swartz found that only about a third of patients with schizophrenia reported improvements in their quality of life when they stayed on their medicines. Even then, the gains were modest. He concluded that successful drug therapy must be accompanied by intensive support, including family counseling, vocational training and regular contact with doctors and other professionals.
Both studies are published in the March issue of the American Journal of Psychiatry.
"Increasingly, the only treatment folks with schizophrenia get is drug therapy," Swartz said. "The hope is that there's going to be a silver bullet and, increasingly, the evidence is that there isn't one."
That revelation might echo particularly loudly in North Carolina, where the state is poised to begin shutting down Dorothea Dix Hospital in Raleigh by the end of the year as part of an effort to keep people with major mental illness out of institutions. Instead, the goal is to treat patients in communities where they live. Most parts of the state, however, still lack the types of services that psychiatrists and mental health advocates say are needed.
"It highlights some of the challenges of mental health reform," Swartz said of his study. "Medicines can ameliorate symptoms, but achieving functional gains that allow you to live, work and get along with people takes other kinds of therapy that are in short supply in North Carolina."
The two schizophrenia studies are the latest results from the $42.6 million Clinical Antipsychotic Trials of Intervention Effectiveness or CATIE project, a massive project launched in 2001 by the National Institute of Mental Health to study mental health drugs. Duke, UNC-CH, Dorothea Dix and other state mental hospitals all participated as study sites.
Initial results published in September 2005 created a stir by reporting that newer and more costly schizophrenia drugs such as Eli Lilly's Zyprexa and AstraZeneca's Seroquel did not work much better than older, cheaper pills. And one older medicine, perphenazine -- which had often been cast aside in favor of newer treatments -- was shown to work as well as all but one of the latest drugs.
The findings surprised psychiatrists, many of whom had thought that the newer medicines would come out on top.
That is hardly news to Ann Akland of Knightdale, whose adult daughter has schizo-affective disorder, a combination of hallucination, delusions and depressive symptoms. Akland is also president of the Wake County chapter of the National Alliance for the Mentally Ill.
She said her daughter, Kristen, started and stopped about five medicines before finding Clozaril about 10 years ago. It was one of the first "next generation" anti-psychotics introduced. As newer drugs came on the market, Akland's daughter, now 27, tried those, but always went back to Clozaril.
"It was the only thing that worked for her," Akland said. Even with medicine, however, Akland said her daughter still has psychotic episodes and needs extensive support to live in the community.
Stroup, the UNC-Chapel Hill psychiatrist, said that the CATIE results have produced valuable clinical information. Psychiatrists now have better information about the specific side effects associated with each of the drugs. They also have more data on which drugs patients fared well on after failing on other medicines.
"It may help people get more effective treatment sooner," Stroup said.
Nonetheless, Stroup said some of his colleagues were disappointed that 68 percent of the 114 patients in the latest drug study stopped taking their medicines. The three newer drugs tested -- Zyprexa, Seroquel and Risperdal -- all had been thought to have less severe side effects than older drugs.
Dr. Brian Sheitman, chief of adult psychiatry at Dorothea Dix and the hospital's associate director for clinical research, said it is typical for people with schizophrenia and other psychotic symptoms to quit taking their medicines. A lot of the time, he said, patients don't recognize they have an illness.
"They don't see the benefits, they don't like the side effects and if they skip a couple of doses they feel better -- it's really not surprising that they stop taking their medicines," Sheitman said. "Unfortunately, these are patients we really don't have good answers for."
