Should we reconsider the way we think about what drugs ‘do’ in schizophrenia? This was the over-riding theme of the opening workshop talk given by Dr Joanna Moncrieff, co-chairman of the Critical Psychiatry Network in the UK and a psychiatrist at University College London.

Dr Moncrieff considers that disease-centred models are not the only way to think about the actions of centrally-acting drugs. She explained that while drugs are typically classed and described according to how they affect the underlying abnormality considered important in a given disease, an alternative is to take a ‘drug-centred’ view of the actions of therapeutic agents. Drug-centred models, according to Dr Moncrieff, would focus on the way in which a pharmacological agent alters what could be considered ‘normal’ functions. In Dr Moncrieff’s model, drugs are viewed according to how they alter the status quo, rather than  how they ‘correct’ a diseased state.

Just ‘treating’ helps

Delegates attending the workshop were also challenged, by the second speaker of the morning, to think about a phenomenon that is often overlooked – the placebo effect. Dr Hugh Middleton is both a social scientist and a psychiatrist, working at the University of Nottingham in the UK. He reminded delegates of the powerful placebo effects in psychiatric medicine – effects which are seen not only in clinical trial settings but which contribute to the efficacy of most treatments given to patients with psychiatric disorders.

The individual view

Chairing the workshop was Dr Sandra Steingard of the University of Vermont and Medical Director at the Howard Center Vermont, who moved the agenda closer to issues relating more specifically to the care and treatment of patients with schizophrenia. She is interested in ensuring that each patient is managed with antipsychotic therapy in a way that avoids drug over-exposure and balances benefits and risks. 

Rounding off the morning session, Dr Stephen Marder, a psychiatrist at the Psychosis Clinic in UCLA, reminded delegates that decisions regarding the on-going treatment of schizophrenia need to be made on an individual basis. He said that just as the psychiatric community should have intelligent, respectful and balanced conversations about the long-term use of antipsychotic agents, it is vital that discussions about treatment take place with, and involve the views of, patients. Dr Marder said that treatment decisions in schizophrenia can have a profound and lasting importance. He reminded delegates that recovery after relapse can take months, during which patients face loosing employment and educational opportunities.