That these studies were NIMH-funded increases our confidence that they are as free from marketing or other bias or “spin” as possible. However, we do notice that the results of the CATIE studies, although broader and denser than our previous knowledge, are confirmatory of the efficacy and side effect data that we already know—data derived from pharmaceutical studies. This observation should increase our confidence in the results of drug registration studies, limited as they are to the comparative efficacy of one (possibly two) compounds.

Most of the editorial is about what the two new studies I wrote about a couple weeks ago:

There has not been a previous set of treatment studies that has so clearly shown the tradeoffs for persons who need antipsychotic medication. There is no clear “winner” among the second generation of antipsychotics, weighing effectiveness and efficacy against side effects, nor a clear “loser.” It is only clozapine that is superior, although its side effects are clearly challenging. These data make it abundantly clear that the risks and benefits of any single medication need to be weighed individually with each patient, and that side effect risk needs to be weighed repeatedly during treatment.

and she goes on to say that more research, especially collaborative research, is needed if we’re to better understand the disorder and how to treat it:

The time is right for innovative collaborations between clinicians, basic and translational neuroscientists, and industry to identify research strategies and successful molecular understanding, thereby promoting rational treatments. Moreover, the field must create and sustain teams of people to test innovative treatments, represented most recently by the CATIE consortium.

“This groundbreaking project builds on years of work by MIND investigators who have
carefully collected the important clinical and brain imaging data that allows for
correlation with exciting new genetic capabilities,” said Dr. S. Charles Schulz, chair of
the Department of Psychiatry at the University of Minnesota and principal investigator of
the MIND Clinical Imaging Consortium.

For more on this, check out their press release or their websites: NCGR and The Mind Institute.

In the first study researchers looked at what happens when the first drug a patient tries fails to relieve symptoms. Patients were randomly prescribed a second drug and Clozaril more effective than more commonly used drugs such as Risperdal, Seroquel and Zyprexa.

In the second study researchers looked at how long patients keep taking their medication. They found that half the patients on Clorazil stayed with it for 11 months or more.

Click here for the full story.

Dr. William W. Eaton, of the Johns Hopkins University, Baltimore, and colleagues analyzed information about 7,704 schizophrenia patients and their parents from three databases (the Danish Psychiatric Register, the National Patient Register, and a register with socioeconomic information) and compared the data with a sample of matched comparison subjects and their parents. They found that a family history of any autoimmune disease was associated with a 45% increased risk of developing schizophrenia. Five autoimmune disorders appeared more frequently in patients with schizophrenia prior to schizophrenia onset as well as in the patients’ parents: thyrotoxicosis, intestinal malabsorption, acquired hemolytic anemia, interstitital cystitis, and Sjögren’s syndrome. More research on family histories of autoimmune disease in schizophrenia patients may provide clues to causal factors common to both types of disorders.

“There is a lack of good-quality evidence to support a conclusion that long-term harm results from short-term postponement of medication in early episode schizophrenia,” Bola said.

His analyzation of six studies regarding treatment of first and second-episode schizophrenia patients will be published in April.

“Sufferers of severe mental illness are good intelligent people who look at the world from many different angles. This makes us seem alien to society, simply because our different thoughts and reasoning often don’t conform to the way society thinks and sees things for themselves…”

Read more about him, schizophrenia, Everest, and his trek here.

They used search engines to mathematically analyze data from 11 studies that assessed negative symptoms in patients with schizophrenia and substance abuse disorders, using the Scale for the Assessment of Negative Symptoms (SANS), and found a moderate effect. Those with substance abuse disoders had fewer negative symptoms compared to those who were abstinent. These results suggest that either substance abuse relieves the negative symptoms of schizophrenia or that the patients with fewer negative symptoms would be more prone to substance use disorders.

The study included 243 subjects: 42 patients with schizophrenia or schizoaffective disorder, 57 of their unaffected first-degree relatives, 38 patients with psychotic bipolar disorder, 52 of their unaffected first-degree relatives, and 54 healthy comparison subjects. Researchers found that “Patients with schizophrenia had increased volume of the lateral and third ventricles and reduced hippocampal volume. None of these volumetric abnormalities was present in psychotic bipolar disorder. ” See summaries in March’s American Journal of Psychiatry and Psychiatry Source for more on the study.

Comments or thoughts? Is imaging technology is a useful way to fine-tune what seem to be the differences between schizophrenia and bipolar?

Researchers used a randomized controlled trial to evaluate the effectiveness of CBT, supportive counseling, and treatment as usual in 309 schizophrenia patients. Outcomes were evaluated at three and eighteen-month followups, using the Positive and Negative Syndrome Scale, the Psychotic Symptom Rating Scales, the Social Functioning Scale, and the Birchwood Insight Scale.

The younger patients responded better initially to supportive counselling than to CBT or treatment as usual, and were harder to engage in therapy; the older patients responded better to CBT although they didn’t show as much of an increase in insight as the younger patients after CBT. This suggests that age-related factors need to be taken into account when using psychological treatments.

Written by Raquel Gur, Professor of Psychiatry, Neurology and Radiology at University of Pennsylvania, and Ann Braden Johnson, a medical writer and psychotherapist, the book “combines scientific expertise - including information about available treatments and up-to -date research findings on schizophrenia - with the practical wisdom of parents who have raised teenagers with this illness.” It provides both an introduction to the disorder as well as practial coping advice from other parents who’ve been there on topics such how to maintain a medication schedule, how to advocate for appropriate treatment, and how to get involved in the politics of mental health issues.

And a new study by researchers at Tokyo Women’s Medical University may help clinicians measure who will be more likely to have problems with complying. Researchers used a Japanese version of the Rating of Medication Influences (ROMI-J) Scale with 90 outpatients who had good compliance for 3 months when they were intially interviewed. They were followed up for two years.

The most frequent reason for compliance at the initial interview was “fear of relapse” and the most frequent reason for noncompliance, not surprisingly, since antipsychotic drugs can have some pretty miserable side effects, was “distressed by side effects.”

In the follow-ups, fifteen of those who hadn’t maintained compliance had higher baseline scores for “no perceived daily benefit,” and sixty-four outpatients who had maintained compliance had higher baseline scores for “fulfillment of life goals.”

The researchers concluded that understanding attitudes of patients toward drug treatments may help predict levels of compliance.

The program is facilitated through the Fraser Health Authority and the Fraser Region Ministry of Children and Family Development, Child and Youth Mental Health and operates in the Lower Mainland of British Columbia. Click here to visit their website and learn more.

In order to help more people get early diagnosis and treatment, and find out more about the early symptoms of the disease, researchers at the University of California in San Francisco have launched a new schizophrenia early diagnosis program. Contact information for this and similar programs worldwide can be found at Schizophrenia.com. We also feature a free screening quiz here, which, while it can’t diagnose any disorders for you, can tell you if may be experiencing symptoms similar to those associated with schizophrenia.