Dr. Pickar is Adjunct Professor of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD. He is also Former Chief, Experimental Therapeutics Branch, Intramural Research Program, NIMH, and Former Director, NIH Clinical Center 4-East Research Ward for Schizophrenia.
The prevalence of schizophrenia in the US is 0.3%. Really? I thank the Treatment Advocacy Center and Dr. Fuller Torrey and Elizabeth Sinclair for bringing attention to the NIMH’s website, which states just that.
A schizophrenia prevalence of 1% of the US population is a foundation fact that has wide implications.1 Torrey and Sinclair discuss this odd error with characteristic pith and accuracy in the March issue of Psychiatric Times.2 The “disappearance” of 2 million patients with schizophrenia is certainly an effective way to bring home the implications of the NIMH error.
The response of NIMH Director Dr. Joshua A. Gordon3 to Torrey and Sinclair’s piece does little to persuade that the NIMH is on point. Pardon this 21th century cynicism, but was there an interest in reporting a lower prevalence figure for the most serious of mental illnesses? Might a lower prevalence suggest that it is less a problem? That we have somehow been successful in reducing its occurrence?
The NIMH error is particularly noteworthy in light of recent Congressional efforts to bring attention to persons who suffer with serious mental illness. The Helping Families in Mental Health Crisis Act approved by the House in 2016 and later incorporated into the 21th Century Cures Act in 2017 highlighted the need for renewed, effective attention to this population by Federal agencies. Does NIMH research meet this challenge?
NIMH Intramural Research beds for schizophrenia at St. Elizabeth’s Hospital in Washington, DC and those at the NIH Clinical Center in Bethesda together numbered in the range of 35 to 45 in the 1970s through 1990s. Research into schizophrenia at the NIH Clinical Center today (there are no longer beds at St. Elizabeth’s Hospital) limps along with few inpatients and lacks supporting energy from “above.” Inpatient research beds represent a national resource for families of patients with schizophrenia. No one has used research beds better than The NCI in its Intramural Research Program.
The NIMH website highlights 2 clinical studies, CATIE and RAISE.CATIE, completed in the 1990s, brought home the fact the new generation of antipsychotic drugs is no more effective than older drugs, leaving clozapine, first used in the 1970s and FDA approved in 1989 for patients with treatment resistance as the only antipsychotic drug with enhanced efficacy. RAISE further demonstrates the limitation of current treatment. Unfortunately, the NIMH has never followed up its own leads to improve the treatment of schizophrenia. Dr. Gordon correctly mentions the importance of neurocognitive deficits of schizophrenia, an area pioneered by Intramural NIMH Clinical Scientists. Despite considerable academic and industry efforts, drug development for these deficits has been entirely unsuccessful. A fresh look is in order.
Perhaps just an oversight, the NIMH error about schizophrenia prevalence prompts a closer examination into NIMH’s attention to schizophrenia. I support the suggestion by Torrey and Sinclair for a new study of the prevalence of schizophrenia. It is also time for an independent review of the NIMH’s research efforts into our most serious mental illness.
Dr. Pickar reports no conflicts of interest concerning the subject matter of this article.
1. Regier DA Narrow WE, Rae DS, et al. The de facto US mental and addictive disorders service system. Arch Gen Psychiatry. 1993;50:85-94.
2. Torrey EF, Sinclair E. Hocus Pocus: How the NIMH made 2 million people with schizophrenia disappear. Psychiatric Times. 2018;35(3):1,10.
3. Gordon J. On the prevalence of schizophrenia—and on the NIMH. Psychiatric Times. 2018(3):35:11.