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2011 in Psychiatry - What This Year Taught Us About Mental Illness (pt. 2/2)

December 19, 2011 Natasha Tracy

Last week we talked about five of the top things that we learned about mental illness last year:

  1. Statistics on Prevalence of Bipolar Disorder
  2. How often is Bipolar Diagnosis Mistaken for Depression?
  3. Predictor of Bipolar Treatment Success
  4. Antimanic Treatment Efficacy - Drugs Compared
  5. Are Two Antidepressants Better Than One?

Today we will discuss 6-10 in part two of this article.

Note: This information is from research and should not be the basis for changing your medication. Everyone is different and people respond to different treatment plans.

6. Is There a Blood Test for Schizophrenia?

2011 saw the introduction of a for-profit blood test for schizophrenia. Now, don't get excited. I, and many others, have come out against it. It would take two whole articles to explain why, but basically, the idea that we understand enough reliable biomarkers to diagnose schizophrenia is ludicrous. Our body of knowledge simply doesn't support this. And while you can, at this time, buy this test, it's reliability and usefulness is highly suspect, in my opinion.

It should be noted that this test is not regulated by the FDA as it is a "laboratory-developed test." This means it is the invention of a single laboratory and cannot be sold (or made available) by other labs. There is no oversight on this kind of test and these types of tests are typically used within a laboratory for research purposes.

7. Is Weight Gain Related to Efficacy of Antipsychotics?

stack of booksThere is an observation that those who gain the most weight from antipsychotics (a common problem) also get the most use from the medication. This would be a troubling development if it were true.

Luckily, it doesn't seem to be.

A study done on the CATIE schizophrenia trial data showed that while people who gain weight, do, anecdotally, seem to benefit more from antipsychotics, this is likely due to greater treatment adherence. In other words, antipsychotics tend to create weight gain and those for whom antipsychotics work, tend to continue to take the medication, and thus gain weight.

8. Can Swtiching Antipsychotics Reduce Metabolic Risk?

A common problem with antipsychotics is that they tend to increase weight and triglyceride levels. This puts one at risk for heart disease and other illnesses. However, aripiprazole (Abilify) seems to do this less so than other antipsychotics, so if patients switch from olanzapine (Zyprexa), quetiapine (Seroquel), or risperidone (Risperdal) to aripiprazole, will that reduce metabolic risk?

It appears so.

Overweight patients with increased cholesterol levels were studied for 24 weeks as they either kept their existing treatment or switched to aripiprazole. (Note that both groups were also enrolled in healthy lifestyle training classes.)

Those in the switching group showed:

  • A greater decrease in weight - important for the prevention of diabetes
  • Lower cholesterol levels equating to a 10% decreased risk in cardiovascular disease
  • Lower triglyceride levels and improved 2-hour insulin levels

However, 43% of switchers discontinued treatment before the 24 weeks were up for reasons that aren't clear as efficacy appeared not to decline and there was no notable differences in side effects between groups.

(My guess? The efficacy actually did decrease for some but in ways not captured by the study data. But that's just a guess.)

Nevertheless, this is very good news for people battling weight gain on antipsychotics.

9. Can People Safely Go From Taking Multiple Antipsychotics to Only Taking One?

mp9004394521Treating with multiple medications is known as polypharmacy and treating with a single medication is known as monotherapy. It is common to see many people with schizophrenia on multiple antipsychotics at the same time. Often a first and second generation antipsychotic are combined. There is little research evidence for this approach, however.

A study investigated whether 127 schizophrenics could go from 2 antipsychotics to 1 antipsychotic without losing efficacy.

In some cases, this appeared to be true. After six months:

  • Of those who moved to monotherapy 69% of people were continuing to take the same, single antipsychotic
  • Of those who remained with polypharmacy, 86% of people were still taking both medications

It appears then, that overall, polypharmacy works better than monotherapy for a subset of people. However, most people could attempt to reduce their antipsychotic use successfully.

10. Do Long-Acting Injectable Antipsychotics Have Better Medication Adherence?

One of the problems with antipsychotics is that people stop taking them. There are many reasons for this but it's thought that 40% of psychiatric patients are only partially compliant with their antipsychotic treatment. Unfortunately, this lack of adherence leads to increased hospital stays and worse.

So perhaps a long-acting injectable antipsychotic that would only have to be taken (for instance) twice a month, might prove to have superior adherence and decrease the risk of hospitalization.

Well, this year there was a randomized study that said no, and an analysis that said yes.

Here's why - if you randomize people to receive and injectable or a pill, you naturally put some people in the injectable group that would take the medication anyway and this throws off your data. Ideally, you'd like a sample who all wouldn't properly take their medication to see what happens but that's not really the kind of thing you can recruit for.

This is why the other study might be considered more useful. This study collected "real-world" data from a clinic in Finland. In this study, use of long-acting injectable antipsychotics in those for whom they were appropriate showed a reduction in hospitalizations by about one-third and a reduction in discontinuation when compared with their oral counterparts.

I hope you learned something. I sure did.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter.

APA Reference
Tracy, N. (2011, December 19). 2011 in Psychiatry - What This Year Taught Us About Mental Illness (pt. 2/2), HealthyPlace. Retrieved on 2022, September 26 from https://www.healthyplace.com/blogs/breakingbipolar/2011/12/2011-in-psychiatry-what-this-year-taught-us-about-mental-illness-pt-22



Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Find Natasha Tracy on her blog, Bipolar BurbleTwitter, InstagramFacebook, and YouTube.

Dr Musli Ferati
December, 28 2011 at 6:18 am

The last five New achievement in 2011 indicates that there are still many unknown fact on real nature of mental illnesses, that disturb both whole community and professionals of mentally Health Service. On the other side patient with mentally disorder remain often the victims of misunderstanding and misuse of psychiatric medication as very sensible and pertain pharmacologic cure. In this direction the ninth item of this review is very intrigued deduction, because as such as I posses psychiatric knowledge, monotherapy is most safety as well as efficacious medication than polypharmacologic approaching. In consequence, the statistical data should take carefully in consideration, when they must to have to clinical daily psychiatric practice. Every patient is oneself clinical "casus morbi". However, neuroscience researches are an useful contribution on improvement of psychiatric treatment of mentally ill patient.

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