Antipsychotics are recommended for schizophrenia because the eivdence shows they work. The evidence is based on a measures which include lots of factors. The measures, or PANSS at least, have been designed to be sensitive to medication and the changes it produces.
Within these measures are the factors which are important to patients. It is a guess on my part that most patients experiencing their first episode want one thing: the cessation of the delusions and hallucinations. It is assumed by patients that this what antipsychotics do however I suspect this may not be what their main effect is. In fact I strongly suspect placebo factors are responsible for the majority of the effect.
I think that's pretty fucked up. Patients are being duped into taking major tranquiliser medication because it's supposed to do what they want: remove the delusions and hallucinations plaguing the individual's internal experience of consciousness. If they knew the drugs achieved the same thing as a lobomtomy and were never invented to treat what patients want they might think twice about trusting their psychiatrist.
I think it is possible to get some information from existing trials by reanalysing the data from existing trials and looking only at the measures which patients expect from antipsychotics for psychosis.
The problem as with almost all research into antipsychotics is it is only possible to compare different chemicals. It may be useful to see if clozapine genuinely is the best treatment for treatment resistant schizophrenia.
It is not possible to re-evaluate current data from trials which are accepted into national commissioning or clinical guidance to see how effective the drugs are compared to an inert pill. The placebo effect dogs psychiatric treatments by being very effective compared to the active treatment, often the inert pill is as effective in high quality reviews using good evidence techniques.
The reason why there are few if any placebo controlled trials in recent times is because the chemical cosh is considered the only treatment and must be used continuously. Current ethical standards mean low dose, no dose or medication postponement are considered lunacy to the hegemony.
Thankfully there are small oases of progressive thinking though the UK is a barren wasteland in this area. There is no large scale treatment option here. Other countries have experimented with alternatives. Papers on these alternatives rarely see the light of day in respected peer review journals. Their sample sizes are small, the researchers budgets are tiny and there is clearly a degree of resistance to entertaining the idea that people can survive without medication.
What's extraordinary is these studies show promising results. The use of alternative paradigms has spread beyond Soteria, moshers's method.
These alternatives allow patients to chose. They also show the ethics of not doing a placebo controlled trial of the chemical cosh based solely on patient-based measures is not impossible because the alternative (if in conjunction with psychosocial stuff) may, in fact, offer better outcomes on measures which psychiatrists are interested.
This research is also vital to the new name for the neuroleptic (literally meaning to seize the nerves), the antipsychotic, and the hope it gives patients.
Especially if these drugs reduce life quality and life expectancy.
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