No 21: Drugs for schizophrenia
Schizophrenia is one of the commonest forms of severe mental illness, affecting up to 1% of people at some time during their lives. Symptoms include delusions, disordered thinking and hallucinations - especially hearing voices - but there is no definitive test for the illness. Drugs are the main approach to treatment, in conjunction with psychological and social help. However, the benefits of old versus new drugs are hotly debated. A new, independent assessment of all known research shows the advantages of new drugs have not been proven.
Treatment of schizophrenia was revolutionised in the 50s by the introduction of drugs called antipsychotics or neuroleptics. But while they control symptoms, such drugs, such as chlorpromazine and haloperidol, can also cause severe side-effects, including sedation, blurred vision and involuntary movements. The latter may be permanent. These problems make the drugs extremely unpopular with some sufferers and their families.
Exciting claims are made for the new antipsychotic drugs, introduced about
10 years ago. Manufacturers say these drugs, such as risperidone and olanzapine, work better, with less harsh side-effects. They are often called atypicals, because they are less likely to produce the involuntary movements common to earlier drugs. Families and patients also seem to prefer them and have lobbied hard for the NHS to prescribe more, despite high costs. Trials, sponsored mainly by drugs companies, mostly conclude they are as effective as older drugs, with fewer unpleasant side-effects. But researchers who systematically analysed all studies say that because the trials are mainly small, short, involve patients not normally seen in everyday practice and report outcomes that mean little in real life, they fail to prove that the new drugs are better. Many of the new drugs also have side-effects, such as weight-gain and blood disorders. Patients on clozapine need regular monitoring to check for a potentially fatal blood condition. Large-scale trials are urgently needed to demonstrate conclusively the benefits of the new drugs. However, research also shows some older drugs, such as sulpiride, may have gentler side-effects than others.
• Further information: try www.york.ac.uk/inst/crd/ehc56.htm or contact the MIND information line on 0345 660163. The National Schizophrenia Fellowship advice line is on 0181-974 6814.