To the Editor: Drs. Currier and Simpson (1) strike me as overoptimistic when they state in the August 1998 Taking Issue column that "developments in psychopharmacology may soon place schizophrenia on the growing list of chronic diseases that were once uniformly catastrophic, but are now truly manageable."
It is true that enormous advances have been made. The newer antipsychotic medications often have greater effect on negative symptoms, and produce less burdensome side effects, than traditional agents. Many patients with refractory schizophrenia respond to treatment with clozapine. The same issue of Psychiatric Services that carried Currier and Simpson's commentary included a study that found clozapine therapy to be associated with a reduced risk of suicide among patients with schizophrenia (2) and a report of a successful pregnancy in a patient with refractory schizophrenia treated with clozapine (3).
Yet many patients with refractory schizophrenia do not respond to clozapine. Others cannot be given clozapine because of the high cost or the need for weekly venipuncture to monitor the risk of agranulocytosis. Clozapine treatment sometimes must be discontinued because of agranulocytosis, leukopenia, or other distressing side effects. Risperidone and olanzapine, while less problematic in some respects, have not proven particularly useful in treating refractory illness.
Thus for many patients who are suffering from schizophrenia, true manageability remains only a dream. If Drs. Currier and Simpson can support their optimism with additional information, I urge them to share it with their readers.
Applications for 1999 Achievement Awards
The American Psychiatric Association is now accepting applications for the 1999 Achievement Awards. The deadline for receipt of applications is January 8, 1999.
The American Psychiatric Association presents the awards each year to recognize programs that have made an outstanding contribution to the mental health field, that provide a model for other programs, and that have overcome obstacles presented by limited financial or staff resources or other significant challenges. The winner of the prize in each of two categories—larger academically or institutionally sponsored programs and smaller community-based programs—will receive a $5,000 grant, made possible by Pfizer, Inc., U.S. Pharmaceuticals Group. The first-prize winners also receive plaques, and the winners of Significant Achievement Awards receive certificates.
To receive an application form or additional information, write Achievement Awards, American Psychiatric Association, 1400 K Street, N.W., Washington, D.C. 20005, or phone 202-682-6173.
Dr. Leeman is clinical professor of psychiatry at the State University of New York Health Science Center at Brooklyn.