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Sunday, 8 July, 2001, 23:12 GMT 00:12 UK
Schizophrenics denied best drugs
Mental health
Many mentally ill people may not be getting the best drugs
Many people with schizophrenia are being denied access to the latest drugs, a report has found.

Research by the Zito Trust found that some areas of the country were almost 10 times more likely than others to prescribe newer, "atypical" antipsychotic drugs.

This is despite a growing body of evidence that atypicals are the best way to treat schizophrenia.


The majority of people with schizophrenia are being denied access to the best and most appropriate treatments

Michael Howlett
Zito Trust
The report is published at the same time as the drugs watchdog the National Institute for Clinical Excellence (Nice) is reviewing atypical antipsychotics.

Michael Howlett, director of The Zito Trust, said: "Our report shows that the majority of people with schizophrenia are being denied access to the best and most appropriate treatments and, instead, are subjected to the disfiguring and stigmatising side-effects of the older drugs.

"This places a heavier economic burden on under-resourced mental health services since patients are less likely to take medications with these side-effects and more likely to relapse and require hospitalisation as a consequence."

Social burden

Schizophrenia is a severe and debilitating illness that places an enormous social and economic burden on patients, their carers and society.


It isn't right that we should still be prescribing the older, typical drugs which we would not choose for ourselves or our relatives

Dr Martin Deahl
The newer, atypical medications have shown advantages over the older, typical medications in terms of both safety and efficacy.

This is backed up by research showing that both psychiatrists and people with schizophrenia favour the atypicals over the typicals.

In spite of this, as the report highlights, fewer than one in five people being prescribed antipsychotics in the UK receives an atypical compared with the United States where almost seven in 10 patients receive atypicals.

Dr Martin Deahl, consultant psychiatrist at St Bartholomew's Hospital in London said: "It is no longer simply enough for an antipsychotic drug to control  hallucinations and delusions.

"Drug treatment today must have a side-effect profile that is acceptable to patients so that we can be sure they will take it.

"It isn't right that we should still be prescribing the older, typical drugs which we would not choose for ourselves or our relatives.

"We are operating, in effect, a 'fail first' policy that amounts to no more than a denial of care."

Side-effects

The report notes that between 50% and 75% of people taking older "typical" drugs experience debilitating and stigmatising muscle spasms and uncontrolled movements.

These movements, known as extrapyramidal symptoms, may become permanent even when treatment is stopped.

Six out of 10 patients surveyed described the side effects of older drugs as "worse that the symptoms of schizophrenia".

The report notes that, although atypicals are more expensive than the older drugs on a "pill for pill" basis, medication accounts for only about 2% of the direct costs of managing schizophrenia.

The major direct cost is hospitalisation and people taking older antipsychotics are more likely to need hospitalisation than those taking newer atypicals.

Mr Howlett said: "It is simply unacceptable that so many people are still being denied access to modern medication that can help them lead normal lives.

"If we are to address this issue, we have to change the basis of interaction with health services from 'we are in control' to 'what can we achieve for this patient?'. 

"This is an issue of basic human rights and we look forward to Nice fulfilling its remit and eradicating this inequity."

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See also:

20 Dec 00 | Medical notes
Schizophrenia: The facts
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