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Advances in Psychiatric Treatment (2005) 11: 277-285
© 2005 The Royal College of Psychiatrists

Another triumph of hope over experience?

REVISITING... TREATMENT OF THE PATIENT WITH LONG-TERM SCHIZOPHRENIA

Ann M. Mortimer

Ann Mortimer became Foundation Chair in Psychiatry at the University of Hull in 1996 (Hertford Building, Cottingham Road, Hull HU6 7RX, UK. Tel: 01482 464565; fax: 01482 464569; e-mail: a.m.mortimer{at}hull.ac.uk), moving from Imperial College London. Professor Mortimer runs assertive outreach for Hull, and rehabilitation services for Hull and East Yorkshire. Her research interests reflect her clinical interests, with a focus on the pharmacological treatment of severe mental illness; she is in addition the lead consultant for maternal mental health in Hull and East Yorkshire, and Deputy Chief Examiner to the Royal College of Psychiatrists. Professor Mortimer has received educational and research funding from all the pharmaceutical companies that produce atypical antipsychotic drugs. These include Novartis, Janssen-Cilag, AstraZeneca, Sanofi Synthelabo, Eli Lilly and Bristol Myers Squibb.

Schizophrenia continues to challenge services: recent advances in antipsychotic drug treatment and psychosocial interventions are hindered by non-adherence, disengagement and substance misuse. Furthermore, new side-effect concerns attach to atypical drugs, and psychosocial interventions may be underresourced or of unproven benefit. It is important to address all issues with which patients, families and carers need assistance, and to take a well-informed, creative approach to pharmacological treatment, using medication according to individual patient need rather than mechanistic adherence to guidelines. Psychiatrists should be realistic in their expectations of patient outcome, accepting outcomes that fall short of recovery and imply long-term supportive care, and insisting that this care be available to their patients. Psychiatrists should support early diagnosis and intervention as being possibly the only means to alleviate the burden of long-term schizophrenia for patients, families and services.




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