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Healthy Skepticism International News

July 2007

Healing schizophrenia : using medication wisely

Healing schizophrenia : using medication wisely
John Watkins
South Yarra, Victoria: Michelle Anderson Publishing Pty Ltd; 2006
paperback, 568pages (includes index, bibliography p. 491-556)
ISBN 0 85572 376 9
RRP : AUD$27.95

Healing schizophrenia: using medication wisely raises many difficult questions in regard to what medication can and can’t do. Understanding the role of antipsychotic medication in schizophrenia is complex and often there are no definitive answers. The author gives a lot of information based on his research and opinion that is hard to find elsewhere and often makes you look at what you think you know, in a different way. This is a unique book in that the author has not just looked at newer medications and the views of current academics and researchers as most modern guidelines do, but has researched back many decades and delved into past practice, research and experiences. It is refreshing that views of people who have taken these medications are included.

The author has gone to great lengths to tease out concepts that can make a vast clinical difference if understood. Examples include the description of the “zombie effect” that can occur through excessively prolonged use of antipsychotics at high dose, highlighting more is often not better. The importance of understanding some of the most disabling subtle adverse effects of these medications such as akinesia, akathisia and bradyphrenia that contributes to negative consequences. Likewise, the description of neuroleptic-induced dopamine receptor supersensitivity that emphasises the risk of severe relapse should there be no gradual controlled medication withdrawal. How the patient feels and the personal experience is strongly emphasised. How the takers of medication need to learn what a particular neuroleptic can do for them and how best to use them, but also their limitations and what they do not do. Emphasis is placed in handing back control of these illnesses to those who are affected and the importance of self help in the aid to recovery.

This book also challenges many theories and beliefs that have now become ingrained as best clinical practice and has lead to greater use in antipsychotic medications. For example, rather than specifically being “antipsychotic”, whether the primary effect is to reduce tension, agitation and irritability. Perhaps neuroleptic or major tranquilliser is a better descriptive than antipsychotic for this group of medications? Also, that beneficial effects of medication do not prove schizophrenia is a biological illness, but it is conceivable that the reverse sequence occurs and that changes in brain chemistry are actually a consequence of severe mental distress rather than its primary cause. Rather than medication needing to be life-long, many people may be able to minimise and possibly cease antipsychotic medication if done with appropriate support and planning. There is also a chapter devoted to the vested commercial interests of the pharmaceutical industry and their powerful influence that adds the necessary scepticism to make us more cautious and questioning when new information is presented and to “take medication with a grain of salt”.

Some will be critical in that much of the statements and arguments are based more on the use of the older typical antipsychotics. However the reality is that we haven’t as yet got much information on the new antipsychotics, especially in relation to long term benefits and consequences. Also, the differences between these two groups of antipsychotics may not be as great as often thought. Others may also say that the book could be shortened because many points are reiterated many times in different chapters. However this tends to be reinforcing.

I would recommend this book to all health professionals involved in the care of people with schizophrenia. This book is written in such a way that the lay person can also gain an understanding about medication use. In today’s society of “so little time” and “so little resources” it has become desirable to think that outcomes will improve by simply giving an antipsychotic. Often the emphasis can be to treat the disease rather than the patient. A book like this gives us a wakeup call to use psychopharmacology more wisely. Foremost, this book gave me optimism that by better understanding antipsychotic medication, we can use these medications so much better.

David P Ellis, B Pharm
Senior Specialist Pharmacist
Pharmacy Department
Women’s and Children’s Hospital
72 King William Rd.,
North Adelaide,
Sth. Australia, 5006.
E-mail: .(JavaScript must be enabled to view this email address)



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