Pharmacotherapy
December 3, 2006

Why bother with the struggle to arrive at a psychotherapeutic-psychoanalytic approach which might be mutative in the schizophrenias, if neuropsychopharmacology is considered the “gold standard” and first line treatment approach?  Goldstein (2003), writing in the New England Journal of Medicine (Goldstein DB: “Pharmacogenetics in the laboratory and the clinic” N Eng J Med 348:553-556, 2003) noted:

“One of the most striking features of modern medicines is how often they fail to work.  Even when they do work, they are often associated with serious adverse reactions” (p. 553).

Sullivan et al (2006) noted that although many persons diagnosed with schizophrenia benefit from long-term pharmacotherapy:

“...the benefits of antipsychotic treatment are inconsistent, incomplete, and often countered by significant side effects-relatively rare, life-threatening conditions (e.g., agranulocytosis, sudden cardiac death), side effects associated with long-term morbidity (e.g., tardive dyskinesia, increased body mass, impaired glucose metabolism), and subjectively unpleasant states associated with nonadherence (e.g., akathesia).  Although most individuals respond to treatment, poor or partial response is common, and many patients require trials of multiple medications” (p.50).

Gabbard and Freedman (2006), in a recent editorial published in the American Journal of Psychiatry (G. O. Gabbard & R. Freedman, Am J Psychiatry 163:2, pp. 182-184), referred to Harvard social psychiatrist Leon Eisenberg’s cautionary comments on the growing neurogenetic and neurobiological reductionism in our field.  They noted:

“These directions recall Leon Eisenberg’s prediction that when the ultimate neurobiological treatment for schizophrenia is someday devised and everyone is marveling over the results on the computer monitor, there may be only one psychiatrist left who will remember to ask the patient, ‘How do you feel’ (p. 183).

Brian Koehler PhD
New York University
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New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net