Schizophrenia, psychosis, hearing voices

Schizophrenia

The conventional medication approach

Antipsychotics are the most commonly prescribed treatment for schizophrenia. In many cases, they reduce psychotic symptoms, sometimes dramatically. They can help address persistent delusions and hallucinations and aid in times of psychiatric crisis, and are sometimes vital to help people reclaim their lives.

 

However, these benefits should be viewed in a broader context that considers the drugs' risks and limitations as well as the many evidence-based non-drug options available. This full view helps individuals and their practitioners make the most informed choices about care. 

 

In that spirit, the following infographic summarizes statistics on the challenges of antipsychotics extracted from a number of gold-standard scientific studies.

See Infographic Footnotes.

Perhaps most troubling are suggestive studies on prolonged antipsychotic use. Although quality data is sparse, the past Director of the National Institute of Mental Health concluded

 

"Remaining on [antipsychotic] medication long-term might impede a full return to wellness". [1]

 

This comment is grounded in research that shows that people with schizophrenia who avoid antipsychotics are much more likely to achieve long-term recovery than those who use them. [2]

 

It is also consistent with a study of people living in recovery from schizophrenia. Although antipsychotics reduced the mental chaos of their acute psychosis, the drugs compromised their ability to function normally. [3]  They found long-term use impeded their recovery; the drug's adverse physical and cognitive effects, combined with a decreased sense of of self-agency in using them, stood in their way.

But even with these negatives, there are many studies that show that antipsychotics reduce the likelihood of psychotic relapse. [4] That is important since relapse can be chaotic and sometimes dangerous.

 

Your health, your choice

Researchers and psychiatrists alike underscore an important point: antipsychotic use is not clear cut - their pros and cons must be carefully weighed by every individual. They are harmful to some, yet essential to others. [5]

 

Unfortunately, the risks and limitations of these drugs make the trade-off decision of their use much more difficult than most people realize.

Appreciating this mixed reality, the American Psychiatric Association, [12] doctors, and patients are becoming much more cautious in using antipsychotics, especially for the developing brain and personhood of children.

Thankfully, there are options beyond drugs.

A growing number of evidence-based non-drug treatments show promise. Like drugs, they are not 'one size fits all'. But nearly all can be used with drugs, they typically have far fewer and milder side effects than drugs, and their use can often help reduce - and in some cases eliminate - the need for drugs. 

 

This is an important step forward since our mind, body, and emotions require a more holistic, integrated, and complete solution than a pill can provide. 

Work with trusted integrative practitioners.

Your doctors and practitioners are your trusted guides. Work closely with them as you evaluate and choose your options of care. Many are joining the paradigm shift to Integrative Mental Health, a discipline with a much larger menu of recovery options that spans the best of conventional and non-drug treatments.

 

Leading voices in mainstream psychiatry speak to the benefits of this paradigm shift. Dr. Kenneth Duckworth, Medical Director of the National Alliance on Mental Illness (NAMI), is clear: "... psychiatric medications... are rarely enough to promote recovery alone... Use of non-medication strategies is crucial for most clinical situations." [6] 

Unfortunately, your current doctors may not offer the full combination of treatments you need. In that case, consider expanding your team with integrative practitioners. Instead of looking only at symptoms and drugs that can reduce them, integrative practitioners often probe to find markers of known causative factors of psychotic distress. This results in personalized treatment customized to your unique bio-individuality and needs. 

Even though Integrative Mental Health shows great promise, non-drug options aren't a panacea. But the expanded menu of options of integrative care offers you many more avenues of recovery and stronger reasons for hope.

An integrated wellness approach

There are thousands of peer-reviewed gold-standard medical studies that support the use of non-drug approaches for mental health recovery. In fact, there are 27 broad non-drug approaches that have proven effective. A subset are most-promising for schizophrenia (download free monograph).

 

It is often best to consider schizophrenia from a holistic perspective that includes many therapeutic options separated into four categories of care.

The "higher" in this diagram we operate (toward Preventive), the better, since these are the approaches that help us sustain mental wellness. However, once we develop psychotic symptoms, it may be helpful to use techniques in multiple categories simultaneously to maximize recovery. 

 

Preventive care

Preventive approaches include a number of common sense practices we can adopt that often have a significant impact on mental health. Ones that have been proven helpful for schizophrenia include a safe home, proper diet, food-allergy care, exercise, calm awareness, social connections, mind-body disciplines (like yoga), and others.

 

Restorative care

Restorative approaches address root-causes and direct influencers of mental health symptoms. They come in two varieties: biomedical and psychosocial. Since our body and mind interact so deeply, it is often helpful to address both at the same time.

 

Biomedical practitioners help identify your unique bio-individuality through blood/urine and other testing, using detailed biomedical test panels. These tests can uncover nutrient imbalances, hormonal issues, amino acid irregularities, food allergies, pathogens, inflammation, toxicities, or other causative factors. To help you locate integrative biomedical practitioners, review our practitioner finder

 

Biomedical testing is important since over 25% of the time, mental health symptoms are caused by or significantly influenced by physical issues. [7] This figure rises to about 50% for those of lower socioeconomic status.

 

Walsh-protocol nutrient therapy has been shown in open label trials to be a particularly effective biomedical treatment for schizophrenia: 75%-80% of people with schizophrenia who undergo 6 months of nutrient therapy report significant symptom improvement and the ability to reduce medication, while about 5% can eliminate medication altogether. [8] Funding is being sought to build the evidence-base for this approach in randomized controlled trials. 

Nurtrient Therapy for Schizophrenia with Dr. Williams Walsh, PhD

Courtesy Walsh Research Institute   www.WalshInstitute.org

Psychosocial practitioners can help identify and address an individual's social challenges, emotional difficulties and unhelpful thinking patterns that can cause or influence psychotic symptoms. Assistance from a trained psychologist or therapist is often helpful to work through issues that may be difficult to overcome alone.

Cognitive Behavioral Therapy for Psychosis and individual psychotherapy have been shown to be helpful. Open Dialog has shown strong success in first-episode psychosis. [9]  A variety of trauma-informed therapies are also available, since childhood trauma is much more common in those with psychosis.

 

In addition, peer support - working with people who have recovered from mental health issues and who can provide first-hand guidance - can be very important. Directories of therapists, psychologists, peer specialists and other psychosocial practitioners are usually available in your community.

 

Symptom-relief care

Symptom relief approaches seek to address residual symptoms not removed by preventive and restorative care. Although antipsychotics are by far the most common symptom relief treatment for psychosis, certain herbs, sensory therapies and very low charge electrical devices can be effective. 

 

In addition, voice coping strategies can help people reduce the occurrence and impact of the voices they hear.

Over-care avoidance

Over-care avoidance limits the use of medical interventions to only what is necessary. Not only is over-care expensive, it can also be harmful.


Polypharmacy (using more than one psychiatric drug at the same time) is one potential form of over-care. It is associated with worsening outcomes [10] and can lead to a prescribing cascade where new drugs are increasingly added to address side effects created by previous ones. The highest risk form of polypharmacy is using multiple antipsychotics. The American Psychiatric Association and American Board of Internal Medicine are actively working to curb this practice.[11] 

 

Over-care avoidance is usually achieved by experimenting to find "minimum effective dosages" - the smallest amount needed to gain significant symptom relief. This helps minimize drug side effects, risks, and withdrawal difficulties. In fact, leading psychiatrists are developing de-prescribing plans to help clients reduce and sometimes eliminate psychiatric drugs as they gain sustainable benefit from non-drug options.[12]  

Resources

Footnote references are removed in the mobile version of this page to respect small screen sizes. They can be found in the desktop version.

 

Please see disclaimer.

References:

[1]  Insel T, National Inst of Mental Health Director’s Blog: Antipsychotics: Taking the Long View, Aug 2013, http://goo.gl/LFmP0V.  

[2]  Harrow M, Do all schizophrenia patients need antipsychotic treatment continuously throughout their lifetime? A 20-year longitudinal study, Psychological Medicine, 2012, PMID: 22340278https://goo.gl/HwUOj8 ; Wunderink et al, Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial, JAMA Psychiatry. 2013, PMID: 23824214.

[3]  Bjornestad, J et al, Antipsychotic treatment: experiences of fully recovered service users. 2017, Journal of Mental Health, https://goo.gl/eqFRtF

[4]  Leucht S et al, Maintenance treatment with antipsychotic drugs for schizophrenia, Cochrane Database Syst Rev. 2012, PMID: 22592725

[5]  Frances A, Setting the Record Straight on Antipsychotics , Huffington Post, 2017, https://goo.gl/54oAqm. 

[6]  Duckworth K, The Sensible Use of Psychiatric Medications, NAMI Advocate Magazine, Winter 2013,  https://goo.gl/GMIuSU.

[7]  Koranyi EK et al, Physical illnesses underlying psychiatric symptoms, Psycho Psychosom. 1992, PMID: 1488499, http://goo.gl/V9Wi23.; Koran L, MEDICAL EVALUATION FIELD MANUAL, 1991, http://goo.gl/TPNL9t, copied 10/30/2013.; Hall RC, Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population, Arch Gen Psychiatry. 1980, PMID: 7416911.

[8]  Walsh W, Nutrient Power Heal Your Biochemistry and Heal your Brain, Skyhorse Publishing, 2014, http://goo.gl/DxoIvQ

[9]  Seikkula J et al, Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies, Psychotherapy Research, 2006, https://goo.gl/7g4N56

[10]  Kingsbury S, Psychopharmacology: Rational and Irrational Polypharmacy, Psychiatric Services, Aug 2001, PMID: 11474046http://goo.gl/PFE3Rk.; Kingsbury S, Psychiatric Polypharmacy: The Good, the Bad, and the Ugly, Psychiatric Times, 1007, http://goo.gl/KIIsId.; Akici A, Rational pharmacotherapy and pharmacovigilance, Curr Drug Saf. 2007, PMID: 18690951.

[11]  American Psychiatric Association, Five Things Physicians and Patients Should Question, Choosing Wisely, 2015, http://goo.gl/t3blZ8

[12]  Gupta S, A Prescription for "Deprescribing" in Psychiatry, Psychiatr Serv. 2016 PMID: 26975524.  Ontario Pharmacy Evidence Network, Deprescribing Guidelines, https://goo.gl/8VpYFx. Grudnikoff E et al, Deprescribing in Child and Adolescent Psychiatry—A Sorely Needed Intervention, Am J Therapeutics, 2017, PMID: 28059976. Gupta, S et al, Deprescribing antipsychotic medications in psychotic disorders: How and why? Betham Science, 2018, https://goo.gl/mR9jJ1. 

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