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July 8, 2013 by Sandra Steingard, MD

A Paradox Revealed – Again

Last week, an important study was published in JAMA Psychiatry. Wunderink and colleagues published results of a follow up study to one he had completed several years ago. In the initial study of first episode psychosis, subjects were randomized to one of two treatment strategies: maintenance treatment (MT) in which they were maintained on drugs for the two year study or drug discontinuation (DR) in which the drugs were stopped and then restarted if symptoms recurred.

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April 22, 2013 by Sandra Steingard, MD

All Sorts of Realities

In previous posts in this series, I noted that the standard treatment of conditions labeled as schizophrenia (and related disorders) is to start neuroleptics early and to continue them indefinitely. This is based on the belief that untreated psychosis is bad for the brain and that relapse is much higher when the drugs are stopped than when they are continued. The rationale for this approach, and my discussion of the limitations of these assertions, were the topics of previous blogs in this series.

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April 14, 2013 by Sandra Steingard, MD

Optimal Use of Neuroleptics, Part 3: Duration of Untreated Psychosis

For the past 20 years, there has been a prevailing concern in psychiatry that psychosis is bad for the brain. The notion is that the psychotic process is in and of itself damaging and therefore every effort should be made to curtail this process in order to forestall further damage. This idea heightened the urgency to initiate drug treatment. When I read Anatomy of an Epidemic, this was one of my most pressing concerns; If I suggested to my patients that they pursue other treatments before starting drug treatment, was I helping or harming them?

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March 31, 2013 by Sandra Steingard, MD

Optimal Use of Neuroleptic Drugs, Pt. II: The Monkeys Were Not Psychotic

I asserted previously that the impression of short term efficacy tends to be inflated. What I mean by this is that there is a general sense – within my profession and among the general public – that neuroleptic drugs are very effective. They are after all what allowed us to shutter our state hospitals. The folk narrative is that the main problem is not that they do not work but that people do not take them reliably so we should therefore put our efforts into getting people to stay on them.

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