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|Clinicians Digest Jan/Feb 2007 - Page 4|
Are Antipsychotic Meds Necessary?
These days, we practically take for granted that antipsychotic medications are the front- line treatment for a first psychotic breakdown. The American Psychiatric Association's treatment guidelines for schizophrenia, for example, recommend initiating antipsychotic medications "as soon as feasible." Several researchers, however, believe that antipsychotic medications for some first-time users are unnecessary and perhaps even contraindicated. For a sizeable percentage of people, they say, milieu therapy--providing a supportive psychoeducation environment that includes individual, group, and family work--should be the first treatment, with medications used if the therapy doesn't work or if clients present a clear danger to themselves or others.
There are several reasons behind the growing discomfort with automatically prescribing antipsychotics. Schizophrenic disorder, like depression, is increasingly seen as an umbrella concept that casts such a wide net over different biological and psychological causes and manifestations that no single treatment is likely to be the most effective. There's also a growing disenchantment with antipsychotics. Despite their initial promise, the new atypical antipsychotics have turned out to have serious side effects and to not be as effective as first thought. Also, the assumption that schizophrenia's damage to the brain inexorably increases over time hasn't been borne out by neuroimaging studies.
In the May issue of Research on Social Work Practice, Associate Professor of Social Work John Bola of the University of Southern California cites several studies that find that between 20 and 40 percent of people who suffer a psychotic episode recover fully or functionally without medications. Bola speculates that some of the control group patients in the studies who improved on antipsychotics might have done equally well without the meds, and he wonders whether meds might actually impede full recovery for some patients.
Which people might need meds and which might recover without them? Preliminary research suggests that people most likely to recover without meds have an absence of paranoia, a first psychotic onset in middle age, a family history of affective disorders, and adequate social functioning and absence of personality disturbances prior to the first onset.