medically considered status as the best treatment for schizophrenia such
some, foolishly, have called for it to be used as a first line
treatment. It was originally taken off license because of its risk to
life however it returned because of its ability to 'treat' when other
medications couldn't. In epidemiological studies in Finland it has been
shown to have the most beneficial effect on total mortality which is a
product of its ability to 'treat' suicide.
The main way it kills patients is through agranulocytosis - a
drug-condition condition where granulocyte levels and other levels of
cells that make up the immune system become depleted such that there is
a risk of death (at a guess through secondary infections). This is why
patients have regular monitoring of blood levels for the first six
months and why the manufacturers recommend it is discontinued if
agranulocyctosis develops. Its noteworthy that levels can drop to danger
points within a few days and these won't be observed even with
recommended bi-weekly checks. Its also noteworthy that a high number of
the low number of people prescribed clozapine are dying much sooner than
they should (data to follow).
There are other effects on morbidity and mortality. From my experience
thses are not known in the general medical community. What is clear from
the evidence that can only come from long term use ithe drug clearly
reduces life expectancy in all users and has directly contributed to the
deaths of a few. Studies have shown that all antipsychotics contribute
to the reduced life expectancy of the individual while they treat the
suicide rate at the same time. This data along with the high rate of
death is ignored by NICE and the NHS, politicans and campaigning
organisations freom my personal experiencing attempting to highlight the
problem last year.
The ethics espoused by Hippocrates are something like "if you don't know
what you're fucking doing then don't be a prick and do harm" as a
central tenet of medical ethics. Even today the modern Hippocratic Oath
is still taken by doctors upon becoming doctors but in reality its
ignored by psychiatry in the example of clozapine. They choose a
treatment that harms because of lack of ability to understand and treat
something that may not actually be an illness. The medical model of
illness means that it makes sense to keep trying more dangerous
treatments, like cancer treatments which use therapies that drastically
reduce quality of life and cause reduced life expectancy because there
is no other way to treat the illness. However there are alternatives
that are safer but cost more and are in need of refinement. These
alternatives lack the multi-billion pound budgets for research and
certain have none of the equally large marketing budgets that
psychopharmaceuticals have. The best ones are often developed in the
fringes of the mental health system. The need is urgent though because
it is immoral to treat what is a behavioural and emotional disorder,
increasingly against their will, with medication that kills.
It is exceptionally good at 'treating' the suicide rate but the
mechanism is important. It is hopefully becoming more recognised that
antipsychotics are like a straightjacket in pill form or a "chemical
cosh" which is why they are now becoming used for treatment of dementia
patients - patients who don't have a diagnosis of schizophrenia. I have
tried to use single quotes to indicate that 'treatment' isn't really
treatment in my opinion. A straight jacket is not really a treatment, in
my opinion, even if it comes in pill form and has lots of well-funded
studies to prove that it is effective. It is my estimation that were
clozapine prescribed for patients with Borderline Personality Disorder
(BPD), a diagnosis that has parasuicide as one of the cluster of
symptoms and a completed suicide rate twice that estimated for
schizophrenia (at 20%) in the upper range of estimates, the study would
show that it also has an exceptionally high ability to 'treat' the
suicide rate associated with that diagnosis. It could potentially be
used to 'treat' many things for the convenience of society, just as
dementia patients are experiencing with the presecription of
antipsychotics for challenging behaviour that have been shown in one
study to reduce life expectancy by 50% (the patients were much older and
the effect of the reduction in life expectancy has been magnified but it
is indicative of the effect on life expectancy in all people given
antipsychotics).
In mental health there are other options and I feel like its so obvious
that there must be another reason as to why an alternative to a life
threatening treatment isn't being developed or considered. BPD has been
shown to be treated by a psychological therapy called Dialectical
Behaviorual Therapy. Its an expensive therapy compared to cheap
Cognitive Behavioural Therapy that NICE have recommended above all other
psychosocial therapies and interventions in their latest schizophrenia
guidelines. Its a new development and has shown success in the treatment
of a diagnosis that's part of a class traditionally conisdered
untreatable and intractible. I would hope that there would be a similar
treatment in development for schizophrenia and psychosis, something that
was being developed with a sense of urgency given the evidence coming
out on how people are dying through 'treatment' with clozapine and other
anitpsychotics. These treatments will also offer better quality of life
and a hope for people afflicted by what is considered the severest, most
dehabilitating and disabling psychiatric diagnosis associated with high
levels of stigma and self stigma, suicides, unemployment and
disadvantage on a number of psychiatric measures.
There are other options and my knowledge in this field is limited. It is
my hope that the International Society for the Psychological Treatment
of the Schizophrenias and Other Psychoses (http://www.isps.org/
<http://www.isps.org/>) is developing the humane option to help people
with the diagnosis of schizoprenia and other psychotic disorders because
it is desperatedly need to save the lives of the thousands of people
prescrbed clozapine and the millions prescribed other antipsychotics.
The number of life years and the quantity of quality of life that would
be increased would offest any costs.
Psychiatry has a long history of gold standard treatments that were
unethical and dangerous. It was the insulin-induced coma (or seizure)
that was the gold standard treatnent for acute schizophrenia/psychosis
in the UK after the end of WWII. It was most significant triumph of the
Randomised Controlled Trial to prove that it wasn't as effective as
other options such as barbituate induced comas/seizures (the lesser of
evils). I am confident that in a decade I will be proved to be right but
in that time there will be a lot of people who would have died
needlessly. Guess no one gives a shit about another dead schizophrenic
though...
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