Recovery From Schizophrenia: Psychiatry And Political Economy

ANTIPSYCHOTIC DRUGS: USE, ABUSE AND NON-USE 237Denver’s seriously mentally ill people. As a result, services have been improvedsubstantially by the creation of a program providing individualized care and supportfor the most seriously ill patients, but the problem of the revolving-door patient hasby no means been eliminated.SIDE EFFECTSThere are further reasons why we should not continue to emphasize drugtreatment at the expense of environmental considerations—why we should usecomprehensive psychosocial approaches to minimize the use of antipsychoticdrugs. Many patients distinctly dislike taking medication. One cause of theirdistaste is the side effects of the drugs. Immediate reactions to the standardantipsychotic medications may include stiffness, shakiness, restlessness or acutemuscle spasms. These “extrapyramidal” symptoms follow closely on the heels ofthe clinical benefits of the medications; positron emission tomography (PET)scans show that clinical improvement occurs when 65 per cent of dopamine-2receptors are blocked by medication and extrapyramidal symptoms occur when78 per cent of these receptors are occupied. 56 So, wherever possible, low doses ofthese medications are clearly to be preferred, and increases of dosage should begradual. Extrapyramidal symptoms may often, but not always, be controlled bytaking anti-Parkinsonian medication. Other adverse reactions to the standardantipsychotics drugs are blurred vision, oversedation, blunting of spontaneity,sexual impotence and failure of ejaculation, epileptic seizures and disorders of theeyes, liver, blood and skin. The long-term risk of developing tardive dyskinesia, aneurological consequence of using standard antipsychotic drugs, has already beenmentioned.Other possible adverse reactions to the standard antipsychotic drugs—and theseare also effects that could help to explain the disappointing influence of thesedrugs on the long-term outlook in schizophrenia—are an increase in postpsychoticdepression and an adverse effect on learning ability. A number ofresearchers have reported that people with schizophrenia treated with standardantipsychotic medications may become more depressed after their acute psychosissubsides, possibly as a result of their drug treatment. Some authors have observedthat post-psychotic depression is associated with the slowing (akinesia) induced bythe standard antipsychotic drugs. 57 In addition to frank depression, as many as 40per cent of people with schizophrenia taking conventional antipsychotic drugsexperience drug-induced dysphoria, an unpleasant subjective experience ofirritability, listlessness, and lack of interest. Some researchers argue that this druginduceddysphoria increases the likelihood that people suffering from psychosiswill abuse street drugs and alcohol, in an attempt to feel better. 58 The neurolepticdrugs also diminish learning capacity in animals, normal subjects and psychiatricpatients. 59 The implication of this side effect is that drug treatment may possiblyreduce the capacity of people with schizophrenia to benefit from programs ofsocial and vocational retraining and add to their employment difficulties.