I wouldn't totally dismiss this as a potential factor affecting Risperdal and Consta, even though the incidence rate is so minuscule. It depends on how much profile this report gets, not just from the FDA and the regular media, but from sales reps from other antipsychotic manufacturers, and patient-advocacy groups like NAMI.
1) Schizophrenics tend to be ambivalent about medication--because for most, albeit not all, their illness feels like a part of them, of their identity. Give them another reason to vacillate, and some will choose to discontinue, or may not comply with the prescription (a probably inaccurate cognition: 'if I take less, I'll have less chance of getting a brain tumor').
2) Frontal lobe dysfunction is seen in schizophrenia, one cannot assume that they will objectively weigh risks and benefits, or the rarity of the event. I have had this conversation with schizophrenic patients:
'I'm afraid of getting tardive dyskinesia'....
(A) but that's very rare with this class of antipsychotics, unlike the older drugs....
'But what if I'm the one who gets it?'
When one has a worldview which is to some degree egocentric, reality is based on phenomenology, not objective verification, facts regarding incidence don't mean as much. If one believes that one has been singled out to receive special communications from the unseen, it is not as much of a stretch to assume that one could also be singled out for the rare adverse event.
3) Families may also decide that they'd rather not have their relative on a med which--spuriously or not--looks like it increases the chance of a 'tumor.' Not that any of the drugs are without issues, but the rare incidence of QTc anomalies has kept Geodon from being a major player.
Perhaps none of this will eventuate. My point is simply that this particular patient population may be more vulnerable to this kind of cognitive distortion, and psychiatrists may simply opt for Seroquel (for example) rather than argue about it. I'll be curious to see prescribing patterns over the next six months.
Harry
NeuroInvestment |
