Revisiting Schizophrenia – A Synopsis

On Brain Blogger there is clearly an avid interest in this particular disorder. This article provides a synopsis of a recent Medscape review, regarding our current state of knowledge. I encourage all who are interested to peruse the original resource.

The following are consensual clinical guidelines regarding the use of neuroleptics — otherwise known as antipsychotics.

  1. They are prescribed only for persons who are clearly psychotic, i.e., delusional, hallucinating or manic.
  2. When prescribed they are to be monitored very closely.
  3. There are very few indications for using two or more of them at the same time.
  4. They are not a first-line intervention for persisting insomnia.
  5. They are not to be used solely for “behavioral dyscontrol” in kids of the elderly.
  6. Finally, there is some clinical evidence for use in those with autism. However, this conflicts with other best practices which I have reviewed, and conflicts with my own clinical judgment.

Given the gradual and wider acceptance of the medical/clinical use of marijuana, it is clearly contraindicated for those who already posses a vulnerability to psychotic states. In fact, so-called “Spiceophrenia” accelerates pre-psychotic conditions and renders clinical care to be more challenging. This evidence is firmly established.

In regards to etiology or pathogenesis, this disorder is deemed to be multi-factorial in causation and expression. Much of what we think we know about it remains largely theoretical with little clinical substantiation.

And finally, regarding bio-medical interventions such as electroconvulsive therapy (ECT), transmagnetic stimulation (TMS), psychosurgery, and gene therapy, there is little or no support of their efficacy. Most behavioral health disorders are thought to be poly-genetic and quite heterogeneous in their expression and treatment.

In summary, we still have a very long way to go in clinically managing schizophrenia in a safe and effective manner.

Stetka, B. (Jan 6 2014). 7 Advances in Schizophrenia. Medscape.

Image via patrice6000 / Shutterstock.

Richard Kensinger, MSW

Richard Kensinger, MSW, has over forty years of clinical experience in behavioral healthcare as a psychotherapist, trainer, consultant, and faculty member in the Psychology Department, Mount Aloysius College. He has also taught at Penn State, University of Pittsburgh, and Temple University. He is also a lover of "football", known in the USA as soccer. He is currently associated for over 30 years with youth "football", 26 as a referee.
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