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David Baxter

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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."
 

Messiahmonkey

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David,

Hi, how are you, long time no chat, yea this article is pretty much correct, as from personal experiance the reason most Schizophrenic's stop taking there meds is either there getting side affects or they feel they do not need any medication, possible for some, because they feel well at the time, and others do not recognise there having any episodes ...

Myself on Haldol 50MG every 6 weeks is pretty good with no noticable side affects, I don't know the entire facts however from my experiance when i was admitted to a pshyc ward because of an episode, for 6 weeks i was on a number of meds, epilum being one,

**Very Important point** In the period of hospitalization i never knew i had any side affects, it was only until that i was released and went home to my natural enviroment that i noticed that i was having side affects, i had to do alot of walking around as i could not sit still and i was not able to go to sleep (being so agitated) before at least midnite till i was tired enough to be able to lay in bed to sleep..

I do not claim to know the entire facts, however in my situation my gp refused to take me off these meds because of the side affects i was getting, so my only choice was to jump off them, untill i had another episode they then prescribed me with new meds, Haldol...the question is...how many Doctors refuse to take patents off/ change there meds...??

One thing i'm questioning is...Are the doctors treating these patents correctly in the first place...??

From my experiance, the last episode was my most servir and i addmitted myself to the local hospital AE, there they gave me some oral valium and i'm not sure but it could have been some valium injections, this treatment knock me out all night, the next morning i awoke in another hospital feeling great...

My question is...was this treatment sufficient to possible cure me of any future episodes as i have not had any further episodes, yes i am on Haldol now, but do/did i really need it...??

Is it possible this method of treatment does quite possible cure one from any future episodes...??

It is of my opinion that if this method does indeed relieve any future episode, they should at least try it out in an hospital inviroment to see if it does indeed actuly work before they administor anymore meds...

My argument is...I do not know or not wether or not that this Haldol is indeed actuly doing anything for me...this i belive we need to find out...

But how are we going to be able to do that now...??

Heres a good example of a shrinks mind....I asked my shrink one day when i can come off meds.....And guess what his reply was...He said when i stop having episodes....LOL well it's been 2 years now without any episodes, it just goes to show you cannot believe what a shrink say's...

So my question is...how does that work??, if he's telling me that i can come off meds when i stop having episodes, that means he has to know that the medication i'm on does indeed do not do anything for me....would you agree..??

Then why am i on meds, if he knows that...???

It is of my opinion, if a patent has not had an episode for a number of years he should be allowed to trial a period off medication..

What do you think..?

P.S. Also i am investigating the relationship between schizophrenia and the date of Birth, do you know of any stats like this and where to find them...

The reason, most hospitalization for mental illness occurs between the ages of 20 - 40 yrs, so from an astrological perspective i'm just curious why it's mostly in that period and it would also be good to know what is the most common DOB that it happens to people...

Also, I'm wondering as alot of patents cannot/do not believe that they are having an episode when told...

What if there was a video/audio tape that could be well created to help a mentaly ill patent understand he/she is having an episode..?

Looking forward to your reply..

Regards
Ron..
 

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