Long term use of antipsychotic medication.

Long term use of antipsychotic medication is one of the challenging contemporary discussions  in our field.

The "traditional" idea, supported by "traditional research" that this pharmacological strategy provides stability by reducing relapse rates, in now challenged by other kind of research that poses that, considered under the "recovery perspective" - i.e, to live a life that deserves to be lived, quoting the Spanish philosopher Adela Cortina- and considering long term side effects, strategies that recommend discontinuing use of drugs, should be considered since they might me more advisable or eligible.

Nowadays, this topic is dealt in many different ways, and gathers a lot of attention in the media. Different authors consider different perspectives. Some (see Robert Whitaker, David Healy, Peter Gøtzsche) claim in different ways that the behavior of the pharma industry has not been correct -to say it politely- when disseminating biased information about the many pros and few cons of pharmaceutical drugs. Some stakeholders from the side of people with living experience write about how to get rid of pills (e.g. Peter Lehman), often disregarding the possibility that they may be useful in some way for some persons at some moments. Even in a strictly clinical perspective, to consider these perspectives (por example, stabilityvs. meaningful life), leads to highly complex scenarios, where many different factors need to be carefully weighted in considering what is he best advise we can offer our patients. (Not forgetting the many other considerations to be included: the most obvious, the right to choose of the person, and the ban of forced treatments derived from a strict interpretation of the CRPD).

In Madrid 2018 we plan to contribute for the best possible discussion of this crucial topic. Following the principle that "research is better that rhetoric", we have decided to invite Joanna Moncrieff, who has been a very visible and active part of this discussion in the last years. She is also connected with a research group on the topic. We are very glad to announce that she was kindly accepted our invitation and will take part of in the Conference.



This is the note she has sent us as abstract for her lecture. Many thanks to her for allowing us to add it to our blog.

"The Bitterest Pills: considering the pros and cons of long-term antipsychotic treatment"
Antipsychotic drugs have been proclaimed as miracle cures, but are hated by many users. However, long-term antipsychotic treatment remains the usual treatment for most people with psychosis or schizophrenia. The proposed talk will explore ideas about how antipsychotics exert their effects and present data on the nature of the mental and behavioural alterations they produce. It will look at evidence for the benefits and harms of long-term antipsychotic treatment and describe the design and progress of a trial comparing a gradual programme of antipsychotic reduction and discontinuation with maintenance treatment. Finally, the talk will consider how to help clinicians and patients to approach the use of antipsychotics in different situations.

Jaime Fernandez, President FEARP.

Jaime A. Fernandez, President FEARP.

Not long ago, I returned to visit the old Psychiatric Hospital of Gran Canaria with students of Psychiatry and Psychology (MIR and PIR) as part of a seminar on History of mental health care. The story of the director of the facilities (a person who accumulated more than 30 years of work in that place) told tricky stories. He said "in past times we were afraid, of the patients; to enter a cell we needed five guards behind a mattress"; or also that "we caused an infection that gave fever to be able to contain them, there was no other way to lower the agitation". The visit to the Psychiatric Hospital took us to another century.

After the visit, a seminar on the current mental health network was given. We experienced a vertiginous jump from 1985 until today. The enumeration of the services created in the last 30 years dizzied the students: services for health (USM, UIB, HD, ETAC, etc.), services for social health (CRPS), social services (CD, residential, work, etc). But the biggest jump in time is the relationship between professionals and patients, now more horizontal. Today people with mental health problems give us lectures, participate in our seminars as trainers, organize events and activities together with us, participate in the decision making of the devices, etc. In Spain there is a model of community mental health care, assertive, the provides psychotherapy, attention at home, health and social care, etc. There is still much to be done and to improve, but giant steps have been taken toward the dignity and effectiveness of care.

Students visiting the Old Psychiatric Hospital in Gran Canaria.

In this transformation, Psychosocial Rehabilitation programs have played a fundamental role incorporating the functional approach. Today no one disputes that Psychosocial Rehabilitation is a fundamental strategy in the treatment of mental health problems and that it has contributed the main advances of the decade in addressing serious mental disorders (such as some evidence-based interventions: family interventions, vocational, neurocognitive, etc.)

Madrid, headquarters of the XIII WAPR 2018 Congress, has played a prominent role in the national development of Psychosocial Rehabilitation. The Madrid network has been an organizational reference. The different Spanish autonomous administrative territories have adopted different types of rehabilitation networks according to their autonomic context, with greater or lesser fidelity, or as an alternative model to Madrid, but always with it as a reference.

The service network in Madrid has also been an example of collaboration between professionals from different administrations (health and social) as well as public and private management. There are four different approaches (health-social, public-private) that have generated multiple debates about the effectiveness of their management, but that seem destined to live together and to understand each other. The 13th WAPR Congress will be an occasion to reflect on all these achievements and the path taken by Psychosocial Rehabilitation in Spain and around the world.

In addition, the XIII WAPR 2018 Congress, as its president R. Guinea has said, pays tribute to a whole generation of professionals, mental health workers and pioneers of psychosocial rehabilitation.

I am a clinical psychologist, and as such I have been witness for decades of the thrust of a progressive psychiatry (which includes all types of mental health professionals) in defense of the dignity of the patients. A movement that has fought, researched and worked to improve the effectiveness of treatments and has spearheaded the defense of the rights of the people affected. Social psychiatry, which was the germ of the WAPR in 1985 and of the FEARP in 2001, together with other groups (AEN, etc.), led in its day the process of the Psychiatric Reform in Spain.

As president of FEARP www.fearp.org) I encourage professionals from all over the world to participate in the XIII WAP 2108 Congress in Madrid, because it will be the privileged place to debate and get infected with the experiences in Psychosocial Rehabilitation that have arisen throughout the world .