Can't You Hear Them? by Simon McCarthy-Jones

Author:Simon McCarthy-Jones
Language: eng
Format: epub
ISBN: 9781784505417
Publisher: Jessica Kingsley Publishers
Published: 2017-04-01T04:00:00+00:00

CHAPTER 35

Antipsychotics: Heart-Warming and Heart-Breaking

Simple questions rarely have simple answers. A case in point is: do antipsychotics help people who hear distressing voices? One of most recent reviews of the effectiveness of treatments for hallucinations presented data from a trial that looked at the effects of five different antipsychotics in 362 people having their first episode of schizophrenia.481 The average patient in this trial started with marked-to-severe hallucinations, but after a year of antipsychotic use they only had absent-to-minimal levels of hallucinations. The percentage of patients with more than mild hallucinations decreased from 100 per cent to only 8 per cent. Wow, you might say, antipsychotics seem to almost completely eliminate hallucinations in over 90 per cent of people, that’s great! However, there was no placebo, or other form of control group, in this trial so we don’t know how many people’s hallucinations could have improved simply due to natural remission, other aspects of being taken into care, or placebo effects.

Placebo effects are likely to be important. A recent six-week randomized controlled trial (RCT) examined the effects of placebos and antipsychotics (olanzapine) in 420 people diagnosed with schizophrenia, whose onset was typically over a decade ago.482 Analyses focused specifically on positive symptoms – a combined measure of hallucinations, delusions and confused thought. Patients fell into four distinct categories of response type. Ten per cent were classed as ‘dramatic responders’, and had on average a 74 per cent decrease in positive symptoms. All these patients turned out to be in the group taking antipsychotics. To put it another way, 17 per cent of all patients taking antipsychotics had a dramatic response. In contrast, people classed as ‘responders’ and ‘partial responders’, who made up 70 per cent of patients, were not statistically more likely to have come from the antipsychotic group than the placebo group. Around 80 per cent of the patients in this trial had previously been on antipsychotics, which they were taken off to participate in this trial of a new antipsychotic. Given this, it is even more remarkable that more patients in the placebo group didn’t show huge exacerbations of positive symptoms following being withdrawn from their other antipsychotics, and even more remarkable that over half of the placebo group had their positive symptoms improve once taken off their antipsychotics (being classified as responders or partial responders). The study hence simultaneously supported and questioned the use of antipsychotics for voice-hearing.

The existence of a group of rapid responders to antipsychotics was also found in a 2014 study that examined the response to antipsychotics of people diagnosed with first-episode schizophrenia.483 This study had the limitation of not using a placebo group, but was at least looking at people who had never been on antipsychotics before. It found that 10 per cent of participants could be classified as rapid responders. Only one factor predicted whether a patient would have a rapid, compared with a gradual, response. This was whether the person had a job when they started taking antipsychotics. It could be

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.