Are There Schizophrenics for Whom Drugs May be Unnecessary or Contraindicated?

Abstract

This study reports that there are schizophrenics who do relatively well long term without the routine or continuous use of antipsychotic medication. Specially selected young males undergoing an acute schizophrenic episode were followed, after hospitalization, for up to three years. While hospitalized they were assigned randomly to either placebo or chlorpromazine treatment. Many unmedicated-while-in-hospital patients showed greater long-term improvement, less pathology at follow-up, fewer rehospitalizations and better overall function in the community than patients who were given chlorpromazine while in the hospital. Factors related to post-hospital outcome were good premorbid history and short-lived paranoid characteristics. Considerations which may have an effect on the successful management of acute schizophrenic patients not on medication are mentioned. The findings underline the need for further study of how to utilize antipsychotic medication more selectively in the treatment of schizophrenia.

Minimal-medication approaches to treating schizophrenia

“…From the 1950s until the late 1970s a series of studies concerning the treatment of schizophrenia with or without antipsychotic medication was conducted in the USA (Wirt 1959;Pasamanick 1967;Schooler 1967;Klein 1973;Carpenter 1977;Goldstein 1978;Rappaport 1978;May 1981). Most were placebocontrolled immediate assignment studies that used only antipsychotic medication in their experimental cohorts (and thus did not attempt to treat the whole person).…”

“…Most were placebocontrolled immediate assignment studies that used only antipsychotic medication in their experimental cohorts (and thus did not attempt to treat the whole person). For the purposes of this review only two bear further scrutiny: the studies conducted by William Carpenter and colleagues at the US National Institute of Mental Health in Maryland (Carpenter 1977) and by Maurice Rappaport and colleagues at the St Agnews State Hospital in California (Rappaport 1978). Both are of note because, unlike the others, they used specially designed therapeutic (albeit hospital-based) milieus that emphasised self-understanding, social adaptation, tolerance of bizarre behaviour, interpersonal support and a willingness to give considerable time and attention to a person going through crisis.…”

“…At 3-year follow-up, 73% of the medicated group had been readmitted to hospital, compared with 8% of those originally given a placebo and thereafter never medicated. The authors concluded that 'antipsychotic medication is not the treatment of choice, at least for certain patients, if one is interested in long-term clinical improvement' (Rappaport 1978). This tradition of research stimulated a long-standing debate concern ing the ethics of medication-free research into the treatment of schizophrenia, which continues to this day (Rothman 1994;Carpenter 1997a;Fins 1997;Wyatt 1997;Moser 2005;Bola 2006).…”

Processus de la psychose chez les jeunes adultes

“…De 15 à 40% seulement des schizophrènes qui vivent dans la communauté peuvent en effet subvenir à leurs besoins (Anthony et al, 1972;Mosher et al, 1971). Rappoport et al (1978) disent que si l'objectif du traitement est de réduire les symptômes, la médication antipsychotique s'impose comme traitement de choix ; mais si le but est l'amélioration clinique à long terme, elle n'est plus le traitement privilégié. Ces auteurs concluent également que l'emploi routinier des phénotiazines semble contre-indiqué pour certains schizophrènes.…”

La schizophrénie insaisissable

“…En fait, certains auteurs soutiennent, sur une base scientifique rigoureuse, que la médication est contre-indiquée dans le cas de certains schizophrènes et même qu'elle peut entraîner des effets néfastes à long terme, à savoir l'induction ou le renforcement des symptômes négatifs, l'augmentation du risque de rechute et d'hospitalisation. Il s'agit d'une voie intéressante à explorer (Klein, 1975;Carpenter et coll., 1977;Rappaport et Coll., 1978;Buckley, 1982).…”