Paradigm Shift to Promote a Revolution of Treatment of Schizophrenia to Achieve Recovery

Abstract

Active schizophrenia is characterized by psychotic symptoms that can include delusions, hallucinations, disorganized speech, trouble with thinking, and a lack of motivation. The introduction of antipsychotics in the 50ties was called a revolution for the treatment of schizophrenia and psychosis and is now a cornerstone of treatment. The effects are considered well documented. Guidelines suggest that all patients be offered antipsychotics. Nearly all patients are medicated. Concerns have been raised about non-responders, and there is no evidence for long-term effects. The validity of the diagnosis of schizophrenia according to the Diagnostic and Statistical Manual Mental Disorders (DSM) is controversial and discussed. Patients experience side effects and low benefits and try to stop. This is considered non-conformance, which can lead to relapse. Therefore, caregivers consider medication necessary and use forced drugging. Antipsychotics reduce psychotic symptoms. New patient laws in many countries aim to promote recovery. The United Nations Special Rapporteur on the Right to Health has called 2019 for «World needs a "revolution" in mental health care». "There is now unequivocal evidence of the failures of a system that relies too heavily on the biomedical model of mental health services, including the front-line and excessive use of psychotropic medicines, and yet these models persist". However, this proposal is highly controversial for clinicians. World Health Organization (WHO) followed up 2021: “New WHO guidance seeks to put an end to human rights violations in mental health care”. "This comprehensive new guidance provides a strong argument for a much faster transition from mental health services that use coercion and focus almost exclusively on the use of medication to manage symptoms of mental health conditions to a more holistic approach that takes into account the specific circumstances and wishes of the individual and offers a variety of approaches for treatment and support". This is highly controversial; however, the United Nations High Commissioner for Human Rights (OHCHR) supported the WHO proposal with a guideline to reform legislation in order to end human rights abuses and increase access to quality mental health care. A realistic path to implement WHO treatment improvements seems to need the courage of legislators to follow OHCHR suggestions and a shift of paradigm.