emotion. One thing I will be suggesting is a review of research looking
only at the measures of the effect of major tranquillisers on delusions
and hallucinations. For many patients this is the core reason why they
accept treatment but the effect of the major tranquilliser on this core
patient measure is unknown because PANSS, BPRS and other measures have
many other factors which may mask the effect of drugs on these two
important factors.
What I am talking about is a retrospective meta-analysis only looking at
these measures. The value of this research will be allowing
psychiatrists to offer patients what they expect from a drug called an
antipsychotic. I hope you would agree that in lay terms psychosis is
about the internal experience of consciousness which is different from
the accept norms which is what is represented by the measures on
delusions and hallucinations. As far as I am aware in the half century
of the use of this drug this research has never been done.
If the research shows one drug to be better than all the rest then it
may be possible to seek new avenues in drug research which more
specifically target the neurotransmitter sites of the drug which best
reduces the delusions and hallucinations. In the one piece of
qualitative research I've read on the effect of clozapine even this
highly dangerous drug doesn't cease the delusions and hallucinations in
all patients.
I hope you would agree with me that this piece of research is worth
doing? By finding drugs which work on what patients want and are more
specific in their neurobiological action it is my hope that there will
be fewer side effects, less physical illnesses caused and patients could
have a better quality of life. It would also meet their expectations and
allow psychiatrists to meet their expectations. The review should also
be relatively cheap to do since there is no need to do a new trial.
I am working on the bit about black people and schizophrenia today. I am
saddened by the results of the Count Me In census. One of the best
resources in the area is the Sainsbury Centre for Mental Health Circle
of Fear report. If you are not aware of it I can send you a link. It was
written back in 2002 and made 15 recommendations, many of which have not
been followed through. These recommendations may be the way to change
the poor experiences of black people with schizophrenia in the future.
The recommendation I will make other than implementing those suggested
in the 2002 SCMH report is, I hope, a way to reduce the overdiagnosis
problem. It is based on this one study and a few other things I've
gleaned about the history of diagnosis and treatment.
Hickling FW, McKenzie K, Mullen R, et al. A Jamaican psychiatrist
evaluates diagnosis at a London psychiatric hospital. Br J Psychiatry.
1999;175:283–285
http://www.ncbi.nlm.nih.gov/pubmed/10645332
"Of 29 African and African-Caribbean patients diagnosed with
schizophrenia, the diagnoses of the British and the Jamaican
psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%)."
From my lay perspective the result from the abstract of this paper (I
admit I have been remiss and not read the full paper nor searched for an
open access copy) shows there is a factor of cultural bias in the
diagnostic practices of UK-trained psychiatrists. I could labour this
point further but I think the above quote from the paper says enough for
me to suggest that West Indian and African psychiatrists may need to
train UK psychiatrists and psychiatry students in how to diagnose
schizophrenia in black people.
I feel this is a simple recommendation which has not been suggested in
any of the documents I've read thus far. This novel approach may mean
that fewer black people will be misdiagnosed with schizophrenia and
therefore incur the ill treatment which is the basis behind the
significant amount of policy work in the area.
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