Use care with schizophrenia meds, researcher says

As a researcher who raised concerns about what antipsychotics can do to the brain, Nancy Andreasen emphasized one message Wednesday in talks with Episcopal Hospital's psychiatric staff and students:

The drugs are still worth using in people with schizophrenia, but should be used as sparingly as possible, especially in children and the elderly.

"It doesn't mean that we shouldn't be using antipsychotics," said Andreasen, chair of psychiatry at the University of Iowa Carver College of Medicine. "It means we should be careful with antipsychotics."

Andreasen, who switched to medicine after getting a Ph.D. in English literature, gave the second annual Cornelius A. Randhare Lecture at Episcopal, part of Temple Health.

William Dubin, Episcopal's chair of psychiatry and behavioral science, introduced Andreasen as "one of the seminal thinkers who helped us in our understanding of schizophrenia." She has written more than 629 papers and 19 books, and was awarded the National Medal of Science.

Andreasen got her bachelor's degree in 1958, but still works full-time and travels widely. She was in the vanguard of psychiatrists who explored biological causes for mental illnesses, and was an early user of magnetic resonance imaging to examine the brain structures of schizophrenic patients.

Some of her best-known work stems from a study that followed more than 500 patients with schizophrenia for 15 years. Another line of her research has focused on creative people.

Andreasen found that the brains of people with schizophrenia shrank more over time than those of normal people. The damage was subtly worse in people with the most exposure to antipsychotic drugs.

"There is a clear link between antipsychotic treatment and brain-tissue loss over time, and that's a scary link," Andreasen said. "I seem to be the only research psychiatrist who's willing to talk about that link."

However, she said her research also found that relapses, which the drugs help to prevent, were associated with worse damage than the drugs.

She said doctors and patients should beware of applying group data to individuals. Not all of the patients lost brain volume. Unexpectedly, that trend was more pronounced in people with negative symptoms such as emotional blunting rather than in those with psychosis.

She is a proponent of spending more time talking with patients rather than just writing prescriptions.

Her research, she said, points to the need for innovative new drugs plus screening for brain impact during drug development. More research is needed into what causes the loss in brain volume.

Her work also showed decreased communication between parts of the brain in schizophrenia.

On the other hand, the creative people she studied - writers associated with the famed Iowa Writers' Workshop - showed enhanced communication among parts of the brain that form associations. She is now studying other highly accomplished people, including scientists.

Her creative subjects and their families also had a higher burden of mood disorders such as depression and bipolar disorder than other groups. Medication helps them, she said, but doctors need to be especially careful about dosage, to let their creativity shine.

"For highly creative people," she said, "you have to be even better at spending time with them and listening."

sburling@phillynews.com

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