558 CHAPTER 12
Either type of antipsychotic medication is considered “successful” when it sig-
nifi cantly reduces symptoms and the side effects can be tolerated. However, some-
times medication is not successful because it wasn’t really given a fi ghting chance:
patients often stop taking their prescribed medication without consulting their doc-
tor, which is referred to as noncompliance. As in the CATIE study, many people
who stop taking their medication—whether in consultation with their doctor or
not—cite signifi cant unpleasant side effects as the main reason.
A unique study set out to investigate the side effects of antipsychotic medica-
tions in healthyparticipants, who took a single dose of each of the following, in
random order: a traditional antipsychotic (haloperidol), an atypical antipsychotic
(risperidone), and a placebo. Both types of antipsychotic medication caused some
side effects that were similar to the negative symptoms of schizophrenia, particu-
larly, but not limited to, alogia, which in this case was due to drowsiness (Artaloytia
et al., 2006). Clearly, there is a need for medications that can reduce symptoms
while not creating side effects that lead people to stop taking the drug.Discontinuing Medication
Given how often patients stop taking their medication, we need to understand the
effects of discontinuing medication. When people with schizophrenia discontinue
their medication, they are more likely to relapse. One study found that among those
who were stable for over 1 year and then stopped taking their medication, 78%
had symptoms return within a year after that and 96% had symptoms return after
2 years (Gitlin et al., 2001). Various studies have found similar results (Cunningham
et al., 2001; Perkins, 1999; Weiden & Zygmunt, 1997). And even up to 5 years
after discharge, patients who had been hospitalized for schizophrenia and then dis-
continued their medication were fi ve times as likely to relapse as those who didn’t
(Robinson et al., 1999). With enough relapses, though, some people begin to under-
stand the need for treatment:
I thought I could live my life without taking medication, but I ended up in the hospital
again. Then it got worse. I started losing my concentration and my memory got bad.
That’s when I fi nally realized I had to take medication.
(Miller & Mason, 2002, p. 25)Preventive Medication?
Acute episodes of psychosis appear to create long-lasting disturbances in brain
activation, cognitive functioning, and social relations. In addition, research sug-
gests that pharmacological treatment administered soon after the fi rst psychotic
episode is associated with a better long-term prognosis, compared to treatment
begun later (Harris et al., 2005; Marshall et al., 2005). Some clinicians and re-
searchers are investigating whether early and aggressive use of antipsychotic
medication can prevent or minimize the long-term damage that psychotic epi-
sodes appear to infl ict (Lieberman, 1999). Moreover, as noted in Chapter 3, some
researchers are exploring whether people who have prodromal symptoms of
schizophrenia (but not enough symptoms to meet the diagnostic criteria for the
disorder) can reduce the likelihood of a later psychotic episodes by taking antip-
sychotic medication preemptively (McGorry & Edwards, 2002; McGorry et al.,
2002). That is, researchers have asked whether preventive medication can help
children and adolescents who have some symptoms but for whom the number
and intensity of those symptoms do not meet the criteria for a psychotic disorder
(Gosden, 2000; Gottesman & Erlenmeyer-Kimling, 2001; Warner, 2002).
Small pilot studies of early intervention with risperidone with at-risk groups
have found some benefi ts, such as decreased positive symptoms (Cannon et al., 2002;
Cornblatt, Lencz, & Obuchowski, 2002; McGorry et al., 2002; Wade et al., 2006).
However, some researchers are concerned about whether adolescents or children,
whose brains are still undergoing rapid development, should be given antipsychotic
medications in the absence of a psychotic episode. All four of the Genain sisters were
treated with medication; only Myra had long stretches of time when she did not need
medication (Mirsky & Quinn, 1988). By 1995, Nora, Iris, and Hester were continuing