Low-Dose Advantage for Schizophrenics

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Low-Dose Advantage for Schizophrenics

In the two years following release from a psychiatric hospital, most schizophrenics tend to benefit more by taking about one-fifth the standard dose of a commonly prescribed antipsychotic drug, according to a report in the September ARCHIVES OF GENERAL PSYCHIATRY. These "minimal doses" are equally effective for those living with family members who display a behavior style considered by some researchers to be a prime cause of schizophrenia.

"Our results suggest a great proportion of the hundreds of thousands of schizophrenics being successfully treated in the community can get by with much less medication without increasing their chances of being rehospitalized," says social worker and study director Gerard E. Hogarty of the University of Pittsburgh School of Medicine.

Minimal doses, Hogarty adds, also caused fewer of the side effects associated with antipsychotic drugs. A severe movement disorder known as tardive dyskinesia occurs in a substantial minority of patients receiving standard doses (SN: 7/20/85, p.45).

"What is needed to implement a program of minimal effective [drug] dosing is, essentially, a change of attitude [by clinicians] and a willingness to monitor patients more closely," Hogarty asserts.

For each of 70 schizophrenic patients monitored after discharge from a university-based psychiatric hospital, Hogarty and his colleagues established whether their families were high or low in "expressed emotion." This measure, determined through interviews with all adult family members, assesses criticism and hostility aimed at the schizophrenic individual, as well as emotional overinvolvement in the schizophrenic's life.

Schizophrenia usually involves delusions, hallucinations, incoherent thinking, apathy or inappropriate emotions and the inability to maintain a job or social relations.

Several studies in England and the United States have shown a worsening of symptoms and more rehospitalizations among schizophrenics released to families high in expressed emotion. …