Skip to main content Accessibility help
×
Home
Hostname: page-component-747cfc64b6-dwt4q Total loading time: 0.327 Render date: 2021-06-16T00:00:09.441Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

Author's reply

Published online by Cambridge University Press:  02 January 2018

Matti Penttilä
Affiliation:
Oulu University Institute of Clinical Medicine and Oulu University Hospital, email: Matti.Penttila@oulu.fi
Erika Jääskeläinen
Affiliation:
Oulu University Hospital
Noora Hirvonen
Affiliation:
Oulu University Hospital
Matti Isohanni
Affiliation:
Oulu University Hospital
Jouko Miettunen
Affiliation:
Oulu University Hospital and Medical Research Center Oulu, Finland
Corresponding
E-mail address:
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2014 

Dr Bindman and Dr Kripalani have suggested an analysis of the association between DUP and outcomes in subgroups by specific first-line treatment modalities. Unfortunately, it was not possible to analyse this in our meta-analysis, since none of the original studies had used only one treatment modality, but a combination of them in the early phases of treatment. As Bindman & Kripalani point out, and based on current knowledge of the efficacy of treatments in the early phase of schizophrenia, it would not be ethical to study treatment without antipsychotic medication in a first-episode clinical sample. 1 Also, DUP is usually defined as ending at the initiation of antipsychotic medication, which in clinical practice usually occurs about the same time as other treatment modalities begin; therefore, the included studies give only a little information on the effects of different treatments. However, it is interesting to note that de Haan et al Reference de Haan, Linszen, Lenior, de Win and Gorsira2 investigated the effect of delay in intensive psychosocial treatment by comparing this effect with delay in treatment with antipsychotic medication; and found that delay in psychosocial treatment may be a more important predictor of negative symptoms than delay in antipsychotic treatment.

The discussion about the possible effects of antipsychotics has been rather intense recently. However, the current guidelines for treatment of psychosis and schizophrenia clearly indicate that antipsychotic medications are effective and recommended treatment for active psychotic symptoms, 1 though there is not so much evidence for the long term (i.e. several years of antipsychotic treatments Reference Harrow, Jobe and Faull3 ). Additionally, the clinical use of these medications is not always straightforward because of their known side-effects and the fact that, in all psychiatric disorders and other illnesses in medicine, there are always patients who do not want to take the recommended treatment. This seems to have been the case in the trial pointed out by Bindman & Kripalani. Reference Morrison, Turkington, Pyle, Spencer, Brabban and Dunn4 When considering the long-term effects of antipsychotics, it is evident that the long-term treatment of psychosis needs to be developed further.

We agree that it would be dangerous to see different treatments as alternatives to each other, and it has been shown that in psychiatry a combination of different treatments is, in general, more effective than any of them alone. Reference Cuijpers, van Straten, Warmerdam and Andersson5 Psychotherapy in the early phase of illness could be effective not only in preventing psychosis at prodromal phase, but also in enhancing adherence to antipsychotic medication. 1 Current treatment guidelines do not suggest that treatment of first-episode psychosis should include only antipsychotic medication without psychosocial treatment, but rather state that medication is one of the cornerstones of psychosis treatment. We believe there is still a lot to do in developing both medication and psychosocial treatments for schizophrenia, and hopefully active research can support this development.

References

1 National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Adults: Treatment and Management (Clinical Guideline 178). NICE, 2014.Google Scholar
2 de Haan, L, Linszen, DH, Lenior, ME, de Win, ED, Gorsira, R. Duration of untreated psychosis and outcome of schizophrenia: delay in intensive psychosocial treatment versus delay in treatment with antipsychotic medication. Schizophr Bull 2003; 29: 341–8.CrossRefGoogle ScholarPubMed
3 Harrow, M, Jobe, TH, Faull, RN. Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study. Psychol Med 2014; 44: 3007–16.CrossRefGoogle ScholarPubMed
4 Morrison, AP, Turkington, D, Pyle, M, Spencer, H, Brabban, A, Dunn, G, et al. Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. Lancet 2014; 383: 1395–403.CrossRefGoogle Scholar
5 Cuijpers, P, van Straten, A, Warmerdam, L, Andersson, G. Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta-analysis. Depress Anxiety 2009; 26: 279–88.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.
You have Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Author's reply
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Author's reply
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Author's reply
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *