Academic journal article Indian Journal of Psychiatry

Do Antipsychotics Limit Disability in Schizophrenia? A Naturalistic Comparative Study in the Community

Academic journal article Indian Journal of Psychiatry

Do Antipsychotics Limit Disability in Schizophrenia? A Naturalistic Comparative Study in the Community

Article excerpt

Byline: Jagadisha. Thirthalli, Basappa. Venkatesh, Magadi. Naveen, Ganesan. Venkatasubramanian, Udupi. Arunachala, Kengeri. Kishore Kumar, Bangalore. Gangadhar

Background: Though antipsychotics are effective against symptoms of schizophrenia and prevent relapses, their effect on disability has not been studied in a comparative design. Aim: To compare disability of schizophrenia patients receiving continuous antipsychotic treatment with that of those not receiving or receiving irregular treatment in a rural community setting using a naturalistic comparative study design. Patients and Methods: Disability was assessed in 182 schizophrenia patients living in Thirthahalli Taluk of Shimoga District, Karnataka, using Indian Disability Evaluation and Assessment Scale (IDEAS). Fifty patients (27.5%) were receiving regular treatment in the previous 2 years and their disability was assessed for the period when they were on antipsychotics. The remaining 132 patients (72.5%) had off-antipsychotics periods in the previous 2 years and their disability was assessed for the period when they were off-antipsychotics. Results: Patients on antipsychotics had significantly less disability across all domains of disability and in total IDEAS scores. Multivariate regression analysis showed that treatment status predicted disability scores after controlling for the effects of the confounding factors. Different levels of exposure to antipsychotic treatment were associated with different levels of disability. Conclusions: Treatment with antipsychotics is associated with significantly less disability. There is an urgent need to bring schizophrenia patients under the umbrella of treatment.

Introduction

Antipsychotics have been the mainstay treatment modality in treating schizophrenia; they cause reduction of symptoms and prevent relapses in most schizophrenia patients. However, it is still not clear if they make any meaningful difference to the lives of the sufferers, there is only a modest correlation between the severity of symptoms and disability in schizophrenia.[sup] [1],[2],[3] Antipsychotics are particularly effective against positive symptoms, but these symptoms are poorly correlated with functional outcome. [sup] [4],[5] In spite of the use of antipsychotic drugs for the past five decades, schizophrenia has remained one of the most disabling conditions. It is ranked the ninth leading cause of disability among all the disorders causing disability in the world.[sup] [6] Many authors have stressed the need to focus beyond just the symptom reduction.[sup] [7],[8] Disability is an important outcome that is meaningful for the patients and their family members. Implementation of the Persons with Disabilities Act (PDA) 1995 has enhanced the importance of this outcome dimension.

Do antipsychotics limit disability in schizophrenia? Schizophrenia has a chronic, deteriorating course if untreated. Does treatment with antipsychotics change this course? Existing literature alludes to this question only tangentially. For example, Hegarty et al .[sup] [9] in their meta-analysis of outcome studies spanning over 100 years observed that the proportion of patients with poor outcome has decreased after the advent of antipsychotic drugs, but a direct causal role of antipsychotics cannot be inferred from this. Many authors have observed that early treatment with antipsychotics is associated with better functioning.[sup] [10],[11],[12],[13] However, there are contradictory findings too.[sup] [14],[15] Some skeptics have even criticized the role of antipsychotics for their potential harm on the course of the disease.[sup] [16] Recent editorials in leading journals have been tentative about their help to schizophrenia patients.[sup] [17]

The best way to answer the question as to whether antipsychotic treatment causes better functional outcome is to conduct large-scale, long-term placebo controlled studies,[sup] [18] which at this stage are not possible on ethical grounds. …

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