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Schizophrenia and Medication

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Shifted from the discussion topic Mary's Problem.

Allan Schwartz: ... Before the advent of anti psychotic medications, that is what would happen. In fact, the schoprenia would get progressively worse, with some people ending up in catatonic states.

I wonder Allan, were you aware of the studies that indicate anti-psychotic medications may, in fact, contribute to or create chronicity...

The Trial that Launched the Drug Era

Study: (1964) NIMH Trial. Nine hospitals, 344 schizophrenia patients. Three groups received antipsychotic drugs and one group was treated with placebo.

Six-week results:

- 75 percent of drug-treated patients much improved or very much improved after six weeks.

- 23 percent of placebo patients much improved or very much improved after six weeks.

The Paradox: In a follow-up study one-year later it was discovered that"Patients who received placebo treatment were less likely to be rehospitalized than those who received any of the three active phenothiazines.".

-- One Year After Discharge. Schooler, N. American Journal of Psychiatry 123 (1967): 986-995

... relapse rates rose in direct relation to dosage--the higher the dosage that patients were on before the antipsychotic was withdrawn, the greater the relapse rate. 18 patients were on placebo, and only one got worse over the next six months (6%). Sixty-five patients were on 300 mg. of chlorpromazine and 54% of those patients worsened after the drug was withdrawn. One hundred thirteen patients were on more than 300 mg. of chlorpromazine and 66% of those patients got worse after drug withdrawal.

-- Relapse in Chronic Schizophrenics Following Abrupt Withdrawal of Tranquilizing Medication. Prien, R. British Journal of Psychiatry 115 (1968): 679-86.

The researchers concluded: "Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo--the higher the dose, the greater the probability of relapse."

-- Discontinuation of Chemotherapy for Chronic Schizophrenics. Prien, R. Hospital and Community Psychiatry 22 (1971): 20-23.

Study: Comparison of five-year outcomes for psychotic patients treated from 1947 to 1952 without antipsychotic drugs with five-year outcomes for psychotic patients treated from 1967-1972 with antipsychotic drugs.


1947-1952 group: 45% of patients treated without drugs did not relapse in the followup period and 76% were successfully living in the community at the end of the follow-up period.

1967-1972 group: 31% of patients treated with drugs did not relapse in the followup period. The drug-treated group were also much more "socially dependent" -- on welfare and needing other forms of support than those in the 1947 cohort.

-- Comparison of Two Five-Year Follow-up Studies. Bockoven, J. American Journal of Psychiatry 132 (1975): 796-801.

Other researchers reported similar findings: roughly 50% of discharged schizophrenia patients had remained continuously well through lengthy follow-up periods, which was markedly superior to outcomes with neuroleptics.

See Nathaniel Lehrman, "A state hospital population five years after admission: a yardstick for evaluative comparison of follow-up studies," Psychiatric Quarterly, 34 (1960), 658-681; and H.L. Rachlin, "Follow-up study of 317 patients discharged from Hillside Hospital in 1950," Journal of Hillside Hospital 5 (1956), 17-40.

In this 1977 NIMH study, 49 schizophrenia patients, placed into an experimental hospital program that provided them with psychosocial support were randomized into drug and non-drug cohorts. Only 35% of the non-medicated patients relapsed within a year after discharge, compared to 45% of those treated with medication. The medicated patients also suffered more from depression, blunted emotions, and retarded movements.

-- The Treatment of Acute Schizophrenia Without Drugs. Carpenter, W. American Journal of Psychiatry 134 (1977): 14-20.

In this 1978 study, Maurice Rappaport and his colleagues at the University of California, San Francisco randomized 80 young male schizophrenics to drug and non-drug groups. Only 27% of the drug-free patients relapsed in the three years following discharge, compared to 62% of the medicated group. Most notably, only two of 24 patients (8 percent) who weren’t medicated in the hospital and continued to forgo such treatment after discharge subsequently relapsed. At the end of the study, this group of 24 drug-free patients was functioning at a dramatically higher level than drug-treated patients.

-- Are There Schizophrenics for Whom Drugs May be Unnecessary or Contraindicated? Rappaport, M. International Pharmacopsychiatry 13 (1978):100-111.

Chouinard concluded: "Neuroleptics can produce a dopamine supersensitivity that leads to both dyskinetic and psychotic symptoms. An implication is that the tendency toward psychotic relapse in a patient who has developed such a supersensitivity is determined by more than just the normal course of the illness . . . the need for continued neuroleptic treatment may itself be drug-induced."

-- Pavel Muller and Philip Seeman, "Dopaminergic Supersensitivity after Neuroleptics: Time-Course and Specificity, Psychopharmacology 60 (1978), 1-11.

-- Guy Chouinard, “Neuroleptic-induced supersensitivity psychosis,” American Journal of Psychiatry, 135 (1978), 1409-1410; Chouinard, “Neuroleptic-induced supersensitivity psychosis: clinical and pharmacologic characteristics,” American Journal of Psychiatry, 137 (1980), 16-20.

The International Pilot Study of Schizophrenia began in 1968, and involved 1202 patients in nine countries. At both two-year and five-year follow-ups, the patients in the poor countries were doing much better. The researchers concluded that schizophrenia patients in the poor countries "had a considerably better course and outcome than (patients) in developed countries. This remained true whether clinical outcomes, social outcomes, or a combination of the two was considered."

The second WHO organization study of this type was called the Determinants of Outcome of Severe Mental Disorders. ... This study confirmed the findings of the first: two-year outcomes were much better for the patients in the poor countries. In broad terms, 37 percent of the patients in the poor countries (India, Nigeria and Colombia) had a single psychotic episode and then fully recovered; another 26.7% of the patients in the poor countries had two or more psychotic episodes but still were in "complete remission" at the end of the two years. In other words, 63.7% of the patients in the poor countries were doing fairly well at the end of two years. ... The researchers concluded that "being in a developed country was a strong predictor of not attaining a complete remission."

Although the WHO researchers didn't identify a variable that would explain this difference in outcomes, they did note that in the developing countries, only 15.9% of patients were continuously maintained on neuroleptics, compared to 61% of patients in the U.S. and other developed countries.

-- J. Leff, "The International Pilot Study of Schizophrenia: five-year follow-up findings," Psychological Medicine, 22 (1992), 131-145.

-- Assen Jablensky, "Schizophrenia: manifestations, incidence and course in different cultures, A World Health Organization ten-country study," Psychological Medicine, suppl. 20 (1992), 1-95.

-- Culture and Schizophrenia: Criticisms of WHO studies are answered," by A. Jablensky, N. Sartorius, J.E. Cooper, M. Anker, A. Korten and A. Bertelsen, British Journal of Psychiatry (1994) 165, 434-436.

... 68% of people diagnosed with schizophrenia had recovered and of these 50% never took psychiatric medications and another 25% only took them periodically when they felt they needed them to control symptoms.

-- The Vermont Longitudinal Study of Persons With Severe Mental Illness, II: Long-Term Outcomes of Subjects Who Retrospectively Met DSM-III Criteria for Schizophrenia, by Courtenay M. Harding, Ph.D., George W. Brooks, M.D., Takamaru Ashikaga, Ph.D., John S. Strauss, M.D., and Alan Breier, M.D., American Journal of Psychiatry 144:6, June 1987, 727 at p. 730

Harvard Medical School researchers published a study concluding that outcomes for schizophrenia patients in the U.S. had declined since the 1970s, to the point they were no better than they had been in 1900. They found that since 1986, only 36.4% of patients in the U.S. have had favorable outcomes (or were "improved" during a follow-up period that averaged 5.6 years.)

-- One Hundred Years of Schizophrenia: A Meta-Analysis of the Outcome Literature by James D. Hegarty, M.D., MP.H., Ross J. Baldessarini, M.D., M.P.H., Maricio Tohen, M.D., Dr. P.H., Christine Waternaux, Ph.D., and Godehard Oepen, M.D. American Journal of Psychiatry: 151 (1994), 1409-1416.

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To comment on the above:

Antipsychotic medication was initially embraced only because it seemed more humane than the treatments that had come before -- insulin coma, electroshock, surgical lobotomy, metrazol-induced-seizures, etc. Of course, all of these had once been treatments that reflected the unarguable rationality of pure scientific thought. As for anti-psychotics, it was known from the outset that many people actually worsened with them.

There are, of course, then and now, a number of people who do identify anti-psychotics as enormously helpful to them. However, we could not possibly say that "all" do anymore than we could reliably state that "schizophrenia would get progressively worse" in the pre-medication era. In truth, the recovery rate seems to have been higher and remains higher in developing nations that cannot afford the cost of "modern" treatments. There is also a great deal of evidence that many people recover with forms of treatment that do not include medication at all or use only minimal medication, and these people may fare best of all over the long-term.

See also: Can a Mind Be Well?

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I beg to differ, I've talked to more people who have recovered completely from schizophrenia than those who haven't (which have still been a substantial number.)

In my experience, it seems that schizophrenia cannot be cured, but it may very well go away after a long period of time, though from what I've seen it usually takes from 15-40 years to fade. As far as progressively worse, I have to agree with SE in that there is just as much evidence to believe that medications which treat short term symptoms when used as the baseline for prolonged treatment actually agitate and permeate psychosis instead of halt the progression of the illness. That isn't to say that anti-psychotics aren't completely necessary in many if not most cases in order to at least restore some functionality to the patient's life.

I am an advocate of medication, but I don't believe that it is the only way and I certainly don't believe it is the best way, though sadly it is most often the only option.

I've read holistic reports by a handful of psychiatrists who have experimentally treated their schizophrenic patients with almost unprocessable levels of niacinimide. These reports indicated that after giving their patients up to (don't try this at home) three grams a day of niacinimide and a handful of other B, C and E vitamins that psychosis pretty much evaporated entirely without a trace within a week, allowing formerly crippled if not catatonic psychotic patients to function almost better than the average sane person socially, professionally, and privately. These doctors say that skipping one day's worth of the high dosage of niacinimide would almost immediately lapse the patient back into extreme psychosis, but that a patient who had been taking it as recommended daily for 10 years never again had another episode after the first time he missed his 'dosage'. This sounds too good to be true, but when you're nuts and trapped in a black hole you're pretty much willing to try any avenue that may provide hope and I certainly won't rule out or keep quiet about this potential possibility.

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  • 3 weeks later...

I see the book covers bipolar as well.

I have a gripe about this. I would love to try this but I can't afford the supplements. My medical aid pays for Geodon, which, being relatively new and still under patent, has no generic and is expensive. But they won't cover vitamins or minerals. I literally can't afford orthomolecular medicine, but it would be cheaper for the medical aid. I buy Omega 3 which clinical studies have shown to be effective for depression, but it costs me out of pocket.

The orthomolecular approach places quite a lot of emphasis on many mental problems being due to heavy metal poisoning. Since schizophrenia and bipolar are thought to be linked, would you know which heavy metals are thought to be implicated in these? Of course I am interested in what might contribute to mood swings.

Very interesting studies, SE.

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From the link...

Natural Healing for Schizophrenia and Other Common Mental Disorders is a guide to natural approaches to mental and emotional health. It is organized in terms of schizophrenia but includes material on depression, bipolar, autism, and behavior disorders. The book brings together over a half century of medical and psychiatric research with a detailed exploration of nutrients, herbs and biotypes, and the role of allergies, toxins, hormones, physical condition, and brain biochemistry in mental health.

Natural Healing for Schizophrenia and Other Common Mental Disorders serves to inform and support patients and families, as well as physicians and researchers. It is updated and revised every few years, as new medical knowledge becomes available. Includes a glossary, a comprehensive index, current resources, and extensive references.

Mjolnir, that book looks very interesting. I have heard of orthomolecular approaches, the use of Omega 3s, dietary and lifestyle changes -- some people seem to find success with these methods and I think it's important that we hear them out.

Regretably, I know very little about these approaches. I have come across a few lone individuals in my conversations who were making extensive use of them including one young man who had been formally treated along orthomolecular lines and had only good things to say about it. Food sensitivities have also been implicated for some people -- milk and gluten products in particular -- and some people report relief or improvement as a result of dietary changes.

Will these approaches work for everyone? Probably not. But neither does the current approach to treatment and it gets an abundance of air time.

Meantime, a quick run through a search engine brought up some recommendations from others...

Listed below are the books I have that I've found very helpful to my learning. I hope they give hope to someone else. There is much that can be done.

These are some of the books that I think are extremely helpful.

1. Healing the Mind the Natural Way by Pat Lazarus. This is probably the best introductory book.

2. Natural Healing for Schizophrenia and Other Common Mental Disorders by Eva Edelman This is an extremely enlightening book but difficult to read, particularly for the beginner.

3. Nutrition and Mental Illness-An Orthomolecular Approach to Balancing Body Chemistry by Carl Pfeiffer, M.D., Ph.D. Carl Pfeiffer found nutritional causes of psychotic disorders.

4. Brain Allergies: The Psychonutrient Connection Including Brain Allergies Today : An Update by William Philpott, M.D. and Dwight Kalita Ph.D.

5. Mental and Elemental Nutrients: A Physician's Guide to Nutrition and Health by Carl Pfeiffer, M.D., Ph.D. This classic book is out-of-print and thus has limited availability.

6. Common Questions on Schizophrenia and Their Answers by Abram Hoffer, M.D., Ph.D. This classic in its field is no longer available. Try your library.

Source: Alternative Health

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Luna: Very interesting studies, SE.

It's not what we've been taught/told to believe, is it? As many of us have found out the hard way however, just because we believe something to be true, doesn't mean it is. It has not escaped my attention that one of the factors that may have contributed to my own recovery was a lack of anti-psychotic medications.

Meantime, more from the Shadow side of medicine...

Mind Reading: Discussing the Dark Side of Medicine with Author Carl Elliott

Bioethicist Dr. Carl Elliott's new book, White Coat, Black Hat: Adventures on the Dark Side of Medicine, is a relentless exposé of bad doctoring. The book examines the pervasive and often deadly influence of money in the U.S. health-care system, covering everything from clinical trials that compromise patient safety for little scientific purpose to ghostwritten journal articles that serve mainly to market drugs. The result, Elliott argues, is a medical system in which no one is looking out for the patient.

Indeed, just today we saw a new example of this problem: a study published in the British Medical Journal found that the manufacturer of an antidepressant used in Europe (but, interestingly, not approved by the FDA) did not release data on 74% of the patients in its trials, obscuring the fact that the drug was no better than placebo.

White Coat, Black Hat can best be described as simultaneously fascinating and depressing — which is exactly what I told Elliott when I emailed him for an interview. In response, he said, "If you're depressed, then I'm doing my job," and added jokingly that he'd provide "free Zoloft with every purchase."

Naturally, my first question to him was whether he had chosen to mention that brand name deliberately. "Oh yes," he quipped. "That's so I can collect from Pfizer." (Elliott, a professor of bioethics at the University of Minnesota, does not take pharmaceutical company money.)

We talked about that and some other key issues he covers in his book.

Q: Do you think the medical system has become more corrupt than it used to be? There certainly is a long history of quackery and other such problems.

A: I'm 49. I graduated from medical school in 1987. My father was a doctor so I've been around it all my life. To be honest, it always seemed bad. But there's definitely a huge difference between what I saw in medical school and what my father saw in the 1950s. [Mine] was an era in which the entire market-driven corporate ethos seemed to be making big inroads. There was no shame in talking about medicine as a business — and nobody even blinks now.

Q: If science is the best way that we have of knowing the world and if the most effective treatments are evidence based, but if corporate influences on the medical trials designed to provide that evidence lead to hidden or fabricated data, how can I as a health journalist advocate for relying on "science"? If the science itself is unreliable, is it better than quackery?

A: That's what's so demoralizing about it. We've gotten used to the idea that your doctor might be getting gifts and payments from industry. But once you start to look at the litigation, it turns out that the companies are spinning the data and [some articles are] ghostwritten, and all the best journals are implicated. Where do you go now? I don't have an answer.

Q: Should we ban all industry gifts to doctors?

A: That would work for me. The problem is that medicine is largely self-regulated. There've been professional bodies talking about this forever, [but] it doesn't stop just because the American Medical Association says that doctors can't accept a gift worth more than $50.

Q: I read a study once that found smaller gifts actually have a larger influence on recipients than big gifts.

A: That would really surprise me. I have seen studies suggesting that smaller gifts like pens do have an effect but it's hard for me to imagine that a pen has more effect than $1 million in salary.

Q: I think the idea is that if you are taking a million-dollar salary, you recognize the power of influence and try to work against it, but if you take a pen, you think, "Oh this couldn't possibly matter." But you secretly feel obligated to reciprocate.

A: If you talk to pharmaceutical representatives, that's what they say. The purpose of the gift is not really a bribe; it's to get in the door. What you want is a piece of the doctor's time, for them to feel bad about just saying no. Once you get in the door, especially if you walk in with a couple dozen Krispy Kremes, people do feel a lot worse about treating you badly.

Q: Many people discuss pharmaceutical company marketing and "disease mongering" as if they're always a bad thing. But don't these efforts it also do some good in terms of de-stigmatizing disorders like depression and letting people know there's help for them?

A: It's good and bad. For the stigmatized illnesses, everybody would agree that people would be better off if they were de-stigmatized. On the other hand, de-stigmatizing is a huge marketing opportunity. They're selling you the drug by selling the disease.

(This is my favorite part of the discussion...)

Q: Speaking of which, how did the drug companies manage to sell antipsychotic drugs to so many people?

A: That's a fascinating question. If you had told me when in I was in medical school that a new version of Haldol, essentially, would become the most profitable drug in America, I would have just laughed. No one wants to take those drugs. They make you feel so bad and have such terrible side effects. I would have sworn that nobody except the most severely [ill] and desperate would agree to take them — but it's happened.

[There were a few parts to the] strategy. One was to sell the idea of these drugs being a new kind of antipsychotic medication that don't have the side effects of the old ones. We can now see that that's wrong from all the litigation and the CATIE study [the Clinical Antipsychotic Trials of Intervention Effectiveness, which compared older antipsychotics to newer ones]. These drugs do have side effects, just as much as the old ones. But if you can spin and tweak and manipulate the literature well enough, as the drug companies did, you can sell that idea.

The other part is to market the drugs for other illnesses that nobody ever really thought of treating with antipsychotics. Bipolar is the big one here. Now, everybody's got it. It used to be rare, but you can chart the rise and it goes up with the introduction of "atypical" antipsychotics. [They're also sold] as an adjunct for depression.

Q: It seems to me that it's also partly the result of the "war on drugs." People are afraid of drugs like Valium because they worry about addiction, but they don't have to fear antipsychotics the same way.

A: Yes, they are [even] used for insomnia because they're not controlled drugs — that's a really important point. And it's not just patients who are [scared of addiction]. It's doctors; they are freaked out about prescribing controlled drugs because the DEA is looking over their shoulder. If you give Valium, you have to be really careful, but you can give Seroquel and nobody cares.

Read more: Discussing the Dark Side of Medicine

See also: White Coat, Black Hat - Carl Elliott

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The orthomolecular approach places quite a lot of emphasis on many mental problems being due to heavy metal poisoning. Since schizophrenia and bipolar are thought to be linked, would you know which heavy metals are thought to be implicated in these? Of course I am interested in what might contribute to mood swings.


Well the obvious ones are mercury, lead, cobalt, and arsenic. Nickel, tin, copper and manganese have also been attributed to psychotic illness when in concentrated levels. I personally am allergic to nickel and copper.

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is skitzophrenia really a bad thing guess it's all a matter of opinion, some would say it's a gift that allows you to be anyone you want in life or/and at anytime, i think were all skitzo anyways my opinion, some people just think about it more than others and come to rationalize normality into something that is nothing, if that makes sense, and trust me if they was gonna kill you they would have done it already, if they were reading your mind or brainwashing or whatever through the tv and other electronic devices i doubt there would be as much crime in this world, and also they wouldnt spend time letting the police look for murders & ect. rationalize the crazy that be my advice because a rational mind is a normal mind but then again its all just a matter of opinion, and as for the voices in your head there only in your head, quit thinkin/tellin yourself so much random shit prob. what got you thinkin believing you were hearing voices in the first place, but what do i know....ohh and as for hallucinations i be trippin sometimes but its because i dont get much sleep i dont be trippin out on em, and theres bunch reasons why you could be seein stuff, one is you prob. need some sleep, i gotta excuse for everything, weither im right or not its matter of opinion but i get by and in 'my mind' theres 'nothing wrong' with me.

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  • 2 months later...

A new study has been released regarding negative impacts of long-term antipsychotic use. My own opinion has been that I believe these medications should best be used at the lowest dose possible, for the shortest term possible and only for as long as they are recognized as beneficial by the individual in crisis. I remain opposed to forced treatment with medications or forced electroshock treatment. I am not opposed to people making use of such treatments if they are self-chosen.

In 1991, Nancy Andreasen began a long-running study of first-episode schizophrenia patients, which involved periodically measuring their brain volumes with magnetic resonance scans. In articles published in 2003 and 2005, she reported finding "progressive brain volume reductions" in her patients, and that this shrinkage was associated with a worsening of negative symptoms, functional impairment and cognitive decline. But the implication was that this shrinkage was due to the disease, and that the drugs simply failed to stop it.

"The medications currently used cannot modify an injurious process occurring in the brain, which is the underlying basis of symptoms," Andreasen wrote in her 2003 paper.

However, even as she was publishing those findings, other research--in animals and schizophrenia patients--indicated that the drugs might exacerbate this brain shrinkage (or be the primary cause of it.) Then, in a 2008 interview with the New York Times, Andreasen confessed that the "more drugs you have been given, the more brain tissue you lose."

This was something of a bombshell, particularly since it came from Andreasen, who was editor-in-chief of the American Journal of Psychiatry from 1993 to 2005. Now, in the February issue of the Archives of General Psychiatry, she has published those findings, and thus the bombshell has officially landed in the scientific literature.

In this study, Andreasen took periodic MRI scans of 211 schizophrenia patients treated from seven years to 14 years. She found that long-term use of the old standard antipsychotics, the new atypical antipsycotics, and clozapine are all "associated with smaller brain tissue volumes."

Moreover, she found that this shrinkage was dose related. The more drug a person is given, the greater the "association with "smaller grey matter volumes," she reported. Similarly, the "progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment." Finally, Andreasen reported that this shrinkage "occurs independent of illness severity and substance abuse." Those two factors--illness severity and substance abuse--had "minimal or no effects" on brain volumes.

In this February report, Andreasen does not tie the drug-related brain shrinkage to an increase in negative symptoms, functional impairment, and cognitive decline. But in earlier articles, she did just that. And it is that larger context that makes this February report such a bombshell: When pieced together, this is a story of drug treatment that, over the long-term, causes long-term harm.

The other reason this is such a bombshell is that antipsychotics are widely prescribed now to children, often to control their "behavior," and to adults with bipolar diagnoses. They are being used to treat "non-psychotic" conditions. The risk-benefit analysis for those patients will be dramatically changed by the findings of this study.

One hopes that the study will be widely publicized in the media, and it will stir a vigorous discussion. Here are a few of the questions that I believe need to be asked:

  • Does long-term use of antipsychotics for people diagnosed with psychotic disorders need to be rethought?
  • Is there reason to prescribe these drugs to people with non-psychotic disorders?
  • Should the prescribing of these drugs to children and youth, whose brains are still developing, be halted (or, in essence, banned?)
  • Many adults diagnosed with psychiatric disorders are mandated by court orders to take antipsychotics. Should society have the right to require such treatment, given that the drugs shrink brain volumes and this shrinkage is associated with cognitive decline?

For some time, here has been reason to believe that antipsychotics shrink the brain, and I wrote about this in Anatomy of an Epidemic. But this worry has largely been kept out of the public domain. Perhaps now it will become a public concern, and in particular, one hopes that our society now takes a hard look at whether prescribing such drugs to children is a good thing to do.

Source: http://www.psychologytoday.com/blog/mad-in-america/201102/andreasen-drops-bombshell-antipsychotics-shrink-the-brain

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