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Re: schitsophrenia NMDA and lithium

Posted by med_empowered on July 13, 2005, at 1:07:03

In reply to Re: schitsophrenia NMDA and lithium, posted by linkadge on July 12, 2005, at 20:10:02

hey! The line between schizoaffective and schizophrenia is blurry at best; if you look at most studies, schizoaffective people are lumped in with those with schizophrenia. Interestingly enough, although lithium and other mood-stabilizers are commonly used along with antipsychotics and/or antidepressants in treating schizoaffective disorder, these combinations have **not** been very well studied, and the results in many studies are kind of mixed...lithium, in particular, sometimes helps, but can also do bad things when mixed with tends to increase the risk of neuroleptic malignancy syndrome and, when combined with Haldol (and I beleive some other old-school phenothiazines as well), it can cause a form of permanent brain damage similar to that seen after encephalitis lethargica (neuroleptics alone can produce changes in the brain that are similar to those seen with this disorder; they also often induce so-called "pseudo-Parkinson's" which is just like normal Parkinson's, except the effect is drug-induced and usually reversible upon termination of the medication or lowering of the dosage). Anyway, mood-stabilizers are used for those with schizoaffective disorder on a regular basis, and they are also employed a good bit in those with schizophrenia; the idea seems to be that using lithium, depakote, or the like allows the dosage of the neuroleptic to be lowered substantially (this is similar to the strategy some use in using long-term, medium-to-high dose benzodiazpenes to augment antipsychotics). My personal take on all this is that treatment for most disorders, but especially schizophrenia/schizoaffective disorders, is fundamentally flawed and unimpressive. According to one study I read, the "improvements" in the lives of those with schizophrenia peaked in the 1970s; at best, those with schizophrenia are about as well off as they were in the early 1900s in terms of lifespan, productivity, suicide rates, etc. When you factor in up-front drug/hospitaliaztion costs and the ill-effects of long-term antipsychotic administration, one could argue that those with schizophrenia were better served in the days of hydrotherapy and Quaker-inspired "moral treatment" (which, by the way, was awfully expensive, but seems to have been reasonably effective and benign in terms of potential side-effects). One interesting study--I'll look up the author name, title, etc.--did a head-to-head comparison of antipsychotics and benzodiazpenes in managing the "acute" phase of schizophrenia, the first 4 weeks following an episode leading to hospitalization. These first weeks are usually the hardest in terms of treatment. Anyway, the study found that there were no major differences in efficacy between those who were simply given Valium and those who were given neuroleptics (I believe that this study used atypical neuroleptics as treatment for those in the antipsychotic group, but I'm not quite sure). It would appear that, when one factors in up-front medication costs, patient compliance/non-compliance, and the costs associated with undesirable side-effects (rehospitalization, additional medications, the costs associated with constant "med management") those treated with benzodiazepenes actually received more efficient, well-tolerated treatment than those treated with neuroleptics. And, of course, the famous World Health Organization studies found that many people diagnosed with schizophrenia (based on accepted international guidelines, not necessarily the DSM) actually were more likely to recover in poor nations with strong social support systems than those who lived in welathier, industrial/post-industrial nations that encouraged the long-term use of neuroleptics. In those countries, a majority of people recovered from schizophrenia without the prolonged use of neuroleptics; in the united states and many european countries, it appeared that the vast majority did not recover even with the use of neuroleptics. "Recovery" was measured by rehospitalization, symptom relapse, and, most importantly, long-term disability and economic functioning.




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