Translating advances in schizophrenia treatment: a glass ceiling

McGorry, Patrick D

doi:10.5694/j.1326-5377.2003.tb05282.x

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Reforms to the management of schizophrenia in Australia have stalled

A decade ago, the management of schizophrenia languished in medicine's backwaters. Treatment still occurred in asylums, using drug therapies serendipitously discovered decades earlier. Even these had proved ultimately disappointing and were used in excessive doses, with inevitable serious adverse effects, a great deal of suffering and only modest benefit. Psychosocial treatments were similarly obsolete or simplistic, with a weak evidence base. Therapeutic nihilism was pervasive and stigma profound. The public knew little about schizophrenia and gave little thought to it unless they happened to be directly touched by the disorder in their own lives. The Burdekin Report graphically captured this bleak scenario.1

Department of Psychiatry, University of Melbourne, Parkville, VIC.

Correspondence:

Competing interests:

The author has received unrestricted research grant support for investigator-initiated trials and/or acted as a consultant to Novartis, Janssen-Cilag, Sanofi-Synthélabo, Eli Lilly, Mayne Pharma, Lundbeck and AstraZeneca.

1. Burdekin B, Guilfoyle M, Hall D. Human rights and mental illness. Report of the National Inquiry into the Human Rights of People with Mental Illness. Canberra: AGPS, 1993.
2. Pilling S, Bebbington P, Kuipers E, et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 2002; 32: 763-782.
3. Edwards J, McGorry PD, editors. Implementing early intervention in psychosis: a guide to establishing early psychosis services. London: Dunitz, 2002.
4. Jablensky A, McGrath J, Herrman H, et al. People living with psychotic illness: an Australian Study 1997–98. Canberra: Commonwealth Department of Health and Aged Care, 1999.
5. McGorry PD, Yung AR. Early intervention in psychosis: an overdue reform. An introduction to the Early Psychosis Symposium. Aust N Z J Psychiatry Supplement 2003. In press.
6. Auditor General Victoria. Mental health services for people in crisis. Melbourne: Government Printer for the State of Victoria, 2002.
7. McGorry PD, Killackey E, Lambert T, Lambert M. Summary Australian and New Zealand College of Psychiatrists Guidelines for the treatment of schizophrenia 2003. Australas Psychiatry 2003. In press.
8. Schizophrenia: core interventions in the treatment and management of schizophrenia in primary and secondary care. London: National Institute for Clinical Health Excellence, 2002.
9. Geddes J, Freemantle N, Harrison P, et al. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. BMJ 2000; 321: 1371-1376.
10. Czernansky JG, Mahmoud R, Brenner R. A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. N Engl J Med 2002; 346: 16-22.
11. Meltzer HY, Alphs L, Green AI, et al, for the InterSePT Study Group. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60: 82-91.
12. Morgan V, Castle D, Jablensky A. The use of psychopharmacological and other treatments by persons with psychosis. Canberra: Commonwealth Department of Health and Ageing, 2002.
13. Andrews G, Sanderson K, Corry J, et al. The cost effectiveness of current and optimal treatment for schizophrenia: evidence based medicine is affordable. Br J Psychiatry 2003. In press.
14. SANE Australia. Schizophrenia: costs. An analysis of the burden of schizophrenia and related suicide in Australia. Access Economics Report for SANE Australia, 2002. Available at: http://www.sane.org/szcosts.pdf (accessed Apr 2003).
15. Sartorius N. Stigma: what can psychiatrists do about it? Lancet 1998; 352: 1058-1059.

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