No evidence that early episodes of schizophrenia without medication result in long-term harm

A USC review of published research has found no evidence that early episodes of schizophrenia without medication result in long-term harm for patients, casting doubt on the practice to immediately medicate for a year.

"The question is whether we should rush to treat early episodes with anti-psychotics, often before a clear diagnosis has become evident," wrote John Bola in his study slated for publication in the April edition of Schizophrenia Bulletin.

Bola said the findings are important because the drugs used to treat schizophrenia can have serious side effects in nearly half of patients, from severe weight gain and restlessness to involuntary movement and adult-onset diabetes.

The controversial findings could clear the way for researchers to identify the large number of patients who do not need the drugs for their conditions to improve, said Bola, an assistant professor in the USC School of Social Work.

"It's important to look for the people who don't need medication to prevent overexposure to possible side effects," Bola said. "In the last 25 years, there has been little effort to identify the 25 to 40 percent of those who tend to recover with psychosocial treatment and not need medications."

Bola analyzed six published studies from the 1950s to the present with a majority of first or second-episode schizophrenia subjects.

The drugs available do help most patients, but not all, Bola said.

"There is a lack of good-quality evidence to support a conclusion that long-term harm results from short-term postponement of medication in early episode schizophrenia," Bola said. "A categorical prohibition against such research should be reconsidered."

The American Psychiatric Association recommends anti-psychotic medication for at least a year after diagnosis.

That guideline of immediate drug treatment for the first occurrence of schizophrenia prevents important research on the selective use of medications and psychosocial treatments from happening, Bola said.

"Bola has rekindled attention to an important question in the early treatment of schizophrenia," wrote Nina Schooler of Georgetown University in one of six commentaries that accompanied Bola's study in Schizophrenia Bulletin.

Thomas H. McGlashan, director of the Yale Psychiatric Institute, also provided a commentary. He has been studying schizophrenia since the 1970s and was the author of some of the studies Bola cited.

"I maintain that our ignorance remains as profound as it was 29 years ago and that unraveling the mysteries of schizophrenia still requires observing it under natural conditions, i.e, without antipsychotic medications," McGlashan stated. "On the other hand, medication has revolutionized the treatment of psychosis, and it is absolutely required under certain circumstances."