Good thought. Maybe serum levels of the said drugs be assayed to ensure efficacy or therapeutic levels are met before being labeled as 'resistant'.

Dear Barry

There are no medical tests to diagnose schizophrenia. A psychiatrist must examine the patient to determine the diagnosis . The diagnosis is made based on a thorough interview with the person and their family ( clinical diagnosis ) it can not be correct in some situations Brain scans (such as CT scans or MRIs ) and blood tests can help rule out other diseases with similar symptoms to schizophrenia

Antipsychotic drugs are the most effective treatment for schizophrenia .

Schizophrenia is a disease for life . Most people with this disease must receive antipsychotic medications for the rest of life

People with schizophrenia may need assisted housing, job training and other social support programs . People with the most severe forms of the disease may be unable to live alone . May be required group homes or other long-term housing with the appropriate structure .

Nelson

It is a certain fact that after decades of holding to the theory that schizophrenia is a biochemical imbalance that no one has yet demonstrated conclusively that this is the case. The fact that dopamine antagonists relieve the florid symptoms leads some to the belief that dopamine is the principal factor in the aetiology of the disease.

Those determined to be treatment refractive do not respond to the D2 receptor antagonists but do respond to 5-HT antagonists. The would at least suggest that treatment resistant schizophrenia was a 'different' illness. Diseases cannot be diagnosed by signs alone. As you have pointed out several other organic disorders and psychiatric injury such as PTSD can cause schizophrenia like symptoms. In these cases the psychosis will be relived by drugs but the cause of the so-called chemical imbalance is clearly different.

Before any drugs or even diagnosis it would be wonderful to see a few simple things eliminated... parasites (especially toxoplasmosis), Lymes disease, Pyroluria, Porphyria, heavy metal exposure, medical and other drug reactions, dental and other infections, sleep deprivation, dehydration, nutritional deficiency and changes such as recent vaccines, nicotine patch use, exposure to toxins or sudden life changes. Three days of rest, safety, talk, sleep, hydration and nutrition before any diagnosis. Then 3 more if positive changes are evident.... During this time blood sugar imbalance, over or under thyroid production, faulty methylation, B vitamin deficiency, histamine excess, adrenal imbalance, acetylcholine imbalance and food allergies can be explored.

What if diagnosis and treatment locks in the symptoms along with life long stigma and loss of hope? Perhaps its all a diagnostic error.... There are many areas of resistance to the psychiatric model of treatment and perhaps for good reason. Common sense has to come back into medicine for it to hold its credibility in an age when patients self diagnose via the internet and the lack of real physical evidence of mental illness continues to elude science.

The role of drug interventions in psychiatry has a well documented history and implicates chance and post hoc rationalisations about how drugs might (nb) affect naturally occuring neurotransmitters. Their use is largely to suppress some symptoms and to control the behaviour of mad people who are disruptive to others. It is an abuse of the English language to call this 'medical treatment'. All those on this blog might find it useful to read the work of David Healy and Joanna Moncrieff, both psychiatrists, who explore these matters.

David

I am in frequent contact with Joanna and have spoken on the same platform as David Healy on a number of occasions. I certainly endorse the idea that people should look at their work and that of the Critical Psychiatry Network. Medical treatments come in all shapes and sizes however. Some would call gender realignment or a sex change non-medical, others would consider it so because it lames the 'patient' feel better.

It is actually within the framework of the WHO definition of health to include social and psychological well being, not simply an absence of disease. With this in mind we should perhaps consider the views of the patients before describing all interventions as being an abuse of the term medical treatment.

You are right about the elastic notion of medical treatments. However, in the case of psychiatry they are barely effective. Joanna's research is very strong on dealing with the uselessness of anti-depressants. As for 'anti-psychotics' their iatrogenic impacts are so profound (TD, akathisia, Parkinsonism etc) that when they are given coercively this is a serious human rights issue. About a third of patients relapse despite being constantly being medicated yet all recipients are at risk of iatrogenic damage. This makes psychiatry different. For example, from disaffected service users the term 'psychiatric oppression' has understandably arisen-we do not here of 'dermatological oppression'!

I am afraid that scholars and scientists are not ready to accept reality against their notions. I don't what wrong has been said by Nelson Elias that some has downvoted his response. He is very correct in pointing out that any blood test or imaging cannot help in diagnosing schizophrenia. I know it from personal experience. When my brother suggested to psychiatrist the same diagnostic method to be carried out, he replied what for else than confirming what I already know. Blood test may tell several thing but cannot tell exactly from what mental conditions the patient is passing, imaging will tell some abnormal activity of mind but not why it is. Only good psychiatrist after inquiring the patient and interviewing the relatives can determine its intensity and nature and therefore dosage. Sometimes, there is some sort of "gating" problem, in words of my psychiatrist, persists that is from subconscious words, sentences and other things come into the conscious mind. If it persists for a longer period, mild electric shocks are resorted. It depends how sensitive the patient is and how powerful shock was causing schizophrenia.

A blood test cannot diagnose schizophrenia but it can indicate why some patients are not responding to treatment. Indeed patients are at risk of iatrogenic damage, especially where they are given very large doses of psychotropic medication because the 'normal' dose did not work. Before any medication is given a P450 test should be done.

There is an unhealthy dichotomy in psychiatry where some believe that drugs are the only answer and others believe they are never the answer. There is also a ludicrous brief driven orthodoxy in some areas where all scientific reasoning has been abandoned.

However one might wish to dismiss drug therapy as oppressive and even unnecessary there is a large body of patients who enjoy a quality of life because of medication that 3 decades ago they would never have had a hope of. I am no fan of the profligate use of medication and certainly an enemy of the invention of disease. Our obligation to psychiatric patients is to give them better lives, we cannot cure them and in reality do not know what is wrong with them beyond educated guesses but just because we are deficient in these areas does not mean we should not use every means possible to reduce a persons suffering... and we should keep ideology out of it.

Drugs in psychiatry help some people some of the time. They are not magic bullets and they can harm people and at times kill them. When they are given coercively then this alters the traditional ethical dimension to medical treatment. Ideology is inside everything it cannot be excluded. The idea that science can be separated from ideology is itself an ideological position. My new book Understanding Mental Health: A Critical Realist Exploration (Routledge) appears in October and examines all the curt statements just made.