| The goal is to maximize the life outcomes and quality of life of people with schizophrenia. I think in the conversation here there are two questions: What should the public conversation on schizophrenia be like? And, how should the medical system use antipsychotics in the treatment of schizophrenia? I think, on the first question, the public conversation about schizophrenia is not ideal for improving outcomes. In particular, people in their 20s who have a first psychotic episode need to be pushed by their friends and family to get medical care immediately. Schizophrenia treated early is associated with much better outcomes later in life, and long periods of untreated psychosis are associated with much worse outcomes. I think that poor quality articles like this one sustain that section of the population who distrust psychiatrists, which leads some schizophrenics to seek treatment too late or not at all. On the second question, I think that doctors are doing about as well as they can with antipsychotics with the current state of knowledge. Though it sounds like your concern about overprescription is from experience, and my feelings about the right level of long-term antipsychotic use are much weaker than my feelings about the public conversation. I agree that it would be better for antipsychotics to be better targeted. Measuring individual neurotransmitter levels sounds like a very interesting way to better target treatment, though I don't think it is straightforward to measure neurotransmitters in a living brain. I agree that many patients are on antipsychotics for longer than is necessary. The challenge is distinguishing between patients who should discontinue antipsychotics and the patients who will immediately relapse into psychosis without meds. --- Other thoughts: > It's perfectly normal to wonder how can one administrate something when one doesn't understand it. This is a mischaracterization of the state of the science. Antipsychotics are well understood, though not fully understood. We at this point have decades of data on the efficacy of antipsychotics, the prevalence and severity of side effects. We know most of the interactions between the drug and the body. What is not well understood is the exact mechanism by which these interactions moderate psychosis. > there is no attempt at finding the base neuro-transmitter levels in and out of psychotic phases for each patient before deciding on the posology of a treatment To my non-expert ears this sounds like an interesting approach to make treatment more targeted. I am not aware of a technology that could currently be used to measure neurotransmitters in a living brain, and I worry that measurement would be invasive. > Some people even only have a few episodes every few years and are still put on life-long treatment with all the side-effects that can then be seen. |
That's a very important distinction in the latter part. They are somewhat understood in their action mechanisms, whether VMAT1, VMAT2, D1, D2 receptors etc. But not really in their effectiveness (which is slightly more important, especially to determine administration protocols).
Which is also the point of the article.