(Oct. 4, 2016) Critics of psychiatry who argue that people with schizophrenia would be better off without antipsychotic medication misrepresent the best available evidence, including research on medication and quality of life
(Oct. 4, 2016) Given the harrowing and sometimes dangerous nature of psychosis for both the person experiencing symptoms and others nearby, it is natural that medical providers and family members become focused on symptoms and medications. “Critics of psychiatry who have never spent time with patients and families coping with the ravages of schizophrenia simply do not grasp the tragedy of this illness,” write Ronald W. Pies and Joseph M. Pierre, MDs, in a recent Psychiatric Times commentary.
In “Quality of life and the case for antipsychotics,” the authors review the literature specific to antipsychotic medication and quality of life (QOL) — a subjective condition the World Health Organization defines as a complex of “physical health, psychological state, level of independence, social relationships” and the individual’s relationship to his or her environment.
“In our view,” Pies and Pierre conclude, “when non-clinician critics argue that most patients with schizophrenia would be “better off’ without long-term antipsychotic medication — or that antipsychotics have done more harm than good — they misrepresent the best available evidence. Moreover, patients who impulsively discontinue their medication on the basis of such misinformation are jeopardizing their health, safety and QOL.” Add the authors, “Critics also miss the deep-seated satisfaction that comes when severely impaired patients achieve remission, and even recovery, in which antipsychotic medication plays an important role.”
What the Literature Says
Earlier this year, Pies reviewed studies of the clinical benefits of long-term antipsychotic use for psychotic disorders in Psychiatric Times, where he is emeritus editor in chief. In this commentary, he and Pierre focused on the less-explored “quality of life and what we know about its relationship to antipsychotic use.” Although the concept of “how patients feel and how satisfied they are with treatment” is relatively new in psychiatry and the literature is not extensive, they review a number of research studies on the subject and find that they consistently report antipsychotic medication therapy to be associated with higher QOL.
Among them:
- Vothknecht and colleagues, from a review of 44 trials between 1994 and 2010: “subjective well-being of patients with schizophrenia improved during treatment in almost all studies.”
- Witt and colleagues, from an eight-week trial of long-acting injection versus placebo in 404 acututely ill inpatients with schizophrenia: “All active treatment groups were superior to placebo on the QOL total score.”
- Beasley and colleagues, from a 52-week, double-blind study of whether stable patients taken off active medication treatment would experience greater improvements in QOL than those who were not: “Stable patients with schizophrenia who were taken off active drug treatment experienced no greater improvements in long-term qualify of life than those who were continued on antipsychotic treatment, even in the absence of psychotic symptoms.”
- Bobes and colleagues, from a comprehensive review of QOL in schizophrenia literature: while antipsychotic medications have adverse side effects that can affect QOL, “the longer the length of the illness, the worse the quality of life” and the possibility that a “combination of psychopharmacological and psychotherapeutic treatment improve quality of life.”
Gaps and Conclusions
Because of relatively scant research into the topic, there are “certainly large gaps in our knowledge of how antipsychotic medication affects ‘quality of life,’ as compared with placebo or no medication treatment,” Pies and Pierre acknowledge. Most of the studies that have been conducted are of short-term outcomes and are not randomized or placebo-controlled.
“Nonetheless, our review finds no support for the notion that antipsychotic medication worsens QOL . . . and considerable controlled evidence that antipsychotic treatment improves” quality of life by various measures, for at least the first year and perhaps up to three years, they maintain.
“The decision to continue antipsychotic medication for the long term requires more than a survey of the research literature,” they conclude. “It is a decision based, among other considerations, on the particular patient’s history; risk factors; response to initial treatment; adverse effect burden; and perhaps most important, the degree of suffering and incapacity the patient has endured, as a consequence of having schizophrenia.”
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Pies, RW and J.M. Pierre. (10 August 2016). Quality of life and the case for antipsychotics. Psychiatry Times.
- Pies, Ronald W. (22 February 2016). "Long-term antipsychotic treatment: Effective and often necessary, with caveats." Psychiatry Times.
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