Ignorance over dose levels means patients can put on a stone in just eight weeks, inquiry finds

Powerful anti-psychotic drugs prescribed to people with schizophrenia commonly cause them to put on almost a stone in weight within the first eight weeks, an inquiry has found.

Over 20 antipsychotics are currently available but there is widespread ignorance among psychiatrists about dose levels, therapeutic action and side effects.

Many drugs cause gross weight gain at a  speed which is “startling”, the report says, and it is common for patients to put on  “5 to 6 kgs within two months” of starting  a course and for this to “get worse over 12 months”.

As a result, patients are twice as likely to die from heart disease as the general population and have a two to three fold increased risk of diabetes.

The inquiry report, An Abandoned Illness, follows a year long inquiry by the 14-member Schizophrenia Commission appointed by the mental health charity Rethink.

It found appalling care with dysfunctional and demoralised in-patient units, rising levels of coercion, an absence of compassion  and families ignored.

Severe side effects associated with antipsychotic drugs are a common reason why patients stop using them and decline to the point where they have to be sectioned and re-admitted to hospital. In addition to weight gain side effects include muscle stiffness, parkinsonism, dry mouth and constipation.

But although medication is regarded as the “cornerstone of treatment”, rated by three quarters of patients in a survey as the single most effective support for the illness,  many psychiatrists do not understand how to use it.

The inquiry found  “persistent deficiencies” in prescribing practice including “too many people with drugs prescribed above the maximum prescribing guideline limits.”

 “We were very concerned by what we have heard about poor prescribing practice. Further steps must be taken to eradicate this. Sadly some psychiatrists seem to know little about the pharmacology and interactions of the drugs they prescribe.”

Whilst many patients are excessively drugged, others are failed because they do not get the right drugs. Up to 30 per cent of patients are “treatment resistant” – fail to find a drug that adequately controls their symptoms - and would benefit from the specialised medication, clozapine, if they were offered it.

The report says: “Some people with schizophrenia live a difficult life haunted by continuous voices criticising their every action and by paranoid fears that other people are out to get them . The drug clozapine has been proved to benefit this group dramatically but is prescribed to too few and often after years of needless suffering.”

David Taylor, professor of psychopharmacology at Kings College, London and a member of the commission said patients should be given a choice over their medication. “The person taking the drug is best placed to decide which combination of side effects is tolerable. Patients involved in their treatment are more likely to continue taking it.”

Psychological therapies are also now recognised as effective in schizophrenia, following a transformation in understanding which has recognised the illness is the product of both biological and social causes, such as abuse or neglect.

But the report says it is “shocking” that only one in ten patients receive them, despite being recommended by the National Institute for Clinical Excellence (NICE).

Alison Brabban, consultant clinical psychologist in Tees, Esk and Wear Valley NHS Foundation Trust and a member of the commission said cognitive behaviour therapy was wanted by patients but was being unfairly denied .

“If we had a drug that was shown to provide benefits , was cost effective but was not available, there would be a public outcry,” she said.

Jeremy Laurance was a member of the Schizophrenia Commission