Posted by Larry Hoover on June 7, 2005, at 22:00:09
In reply to This shocked me !!, posted by linkadge on June 7, 2005, at 18:18:21
> Most Americans are unaware that the World Health Organization (WHO) has repeatedly found that long-term schizophrenia outcomes are much worse in the USA and other "developed" countries than in poor ones such as India and Nigeria, where relatively few patients are on antipsychotic medications. In "undeveloped" countries, nearly two-thirds of schizophrenia patients are doing fairly well five years after initial diagnosis; about 40% have basically recovered. But in the USA and other developed countries, most patients become chronically ill. The outcome differences are so marked that WHO concluded that living in a developed country is a "strong predictor" that a patient never will fully recover.
I dunno about that. There are many myths related to medication, and the disorder that underlies it. To what do we attribute the lack of recovery? Maybe it is American society that so stigmatizes these individuals that their recovery is not possible. That is nothing to do with the illness, or the meds.
One issue that I bet everybody is clear on is that neuroleptics cause dyskinesia. Right?
Maybe. From the look of these two studies, maybe at the worst, they might bring it on sooner in susceptible individuals (that's my own interpretation of the full-text articles). But the incidence is the same, in a life-span perspective, when comparing neuroleptic-treated and untreated schizophrenics.
Lar
Br J Psychiatry. 1996 Feb;168(2):221-6.
Abnormal movements in never-medicated Indian patients with schizophrenia.
McCreadie RG, Thara R, Kamath S, Padmavathy R, Latha S, Mathrubootham N, Menon MS.
Clinical Research, Crichton Royal Hospital, Dumfries.
BACKGROUND: Historical records suggest dyskinesia was observed in severely ill institutionalised patients with schizophrenia in the pre-neuroleptic era. More recent work has not found dyskinesia in never-medicated younger and middle aged patients. The present study complements this recent work and avoids the confounders of severity of illness and institutionalism by examining elderly patients in a wide variety of community settings. METHOD: Movement disorders were examined in 308 elderly individuals in Madras, India, using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Patients' mental state was assessed by the Positive and Negative Syndrome Scale. RESULTS: Dyskinesia was found in 15% of normal subjects (n = 101, mean age 63 years), 15% of first degree blood relatives of younger schizophrenic patients (n = 103, mean age 63 years), 38% of never medicated patients (n = 21, mean age 65 years) and 41% of medicated patients (n = 83, mean age 57 years). The respective prevalences for Parkinsonism were 6%, 11%, 24% and 36%; and for akathisia 9%, 5%, 21% and 23%. Dyskinesia was associated with negative schizophrenic symptoms. CONCLUSIONS: Dyskinesia in elderly schizophrenic patients is an integral part of the illness and not associated with antipsychotic medication.
J Clin Psychiatry. 2000;61 Suppl 4:10-4.Prevalence of spontaneous dyskinesia in schizophrenia.
Fenton WS.
Chestnut Lodge Hospital, Rockville, MD 20850, USA. WSFMD@AOL.COM
Spontaneous abnormal involuntary movements phenomenologically identical to neuroleptic-induced tardive dyskinesia have been described in schizophrenia for over a century. Because at present nearly all patients with schizophrenia are exposed to neuroleptic medications, information about the prevalence of spontaneous dyskinesia is obtained from accounts from the preneuroleptic era, evaluations of first-episode patients before neuroleptic treatment, and the identification and assessment of drug-naive patients in developing countries. In this report, data from 14 studies of neuroleptic-naive patients with schizophrenia are used to generate age-adjusted estimates of the prevalence of spontaneous dyskinesia. While the precision of this estimate is limited by the difficulty of obtaining large, untreated samples, available data suggest a spontaneous dyskinesia rate of approximately 4% in first-episode schizophrenic patients, 12% for patients ill several years but below age 30 years, 25% for those aged between 30 and 50 years, and 40% for those aged 60 years or older. Relative to the incidence and accrued prevalence of spontaneous dyskinesia expected during the natural history of untreated schizophrenia, the cumulative impact of treatment with new neuroleptic agents has yet to be determined.
poster:Larry Hoover
thread:509280
URL: http://www.dr-bob.org/babble/20050606/msgs/509428.html