Dr Meyer on the Point of Futility in Treating Schizophrenia

In his Psych Congress 2022 session "Using Antipsychotic Plasma Levels to Improve Measurement Based Care," Jonathan M Meyer, MD, clinical professor of psychiatry at the University of California, San Diego, examines the point of futility in the treatment of schizophrenia, oral medication nonadherence, and more. Psych Congress Network sat down with Dr Meyer afterward to answer a few more questions, define the point of futility, and learn why more is not always better.

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Hear more from Dr Meyer here: Making Space for Patient Needs When Treating First-Episode Schizophrenia With Dr Jonathan M. Meyer

Jonathan M Meyer, MD, is a clinical professor of psychiatry at the University of California, San Diego and a distinguished fellow of the American Psychiatric Association. Dr Meyer is a graduate of Stanford University and Harvard Medical School, finished his adult psychiatry residency at LA County-USC Medical Center and completed fellowships there in consultation/liaison psychiatry and psychopharmacology research. Dr Meyer has teaching duties at UC San Diego and the Balboa Naval Medical Center in San Diego and is a consultant to the first episode psychosis programs run by Balboa NMC and the State of Nevada.

Read the transcript: 

Among the concepts that I developed in my work with state hospital clinicians was the point of futility. We had a number of prescribers who somehow thought that if it could give somebody enough Haloperidol, they could make them better. And what happened was these patients were not going to develop D2-related adverse effects no matter how much you gave them but they also were not going to get better. The point of futility expresses the idea that there's a subgroup of people for whom D2 blockade is probably not going to solve their problem, and that more is not necessarily better even if they tolerate it.

The idea is that beyond a certain point, the evidence base for most antipsychotics is that you've reached a point where if you go beyond it, even if they tolerate it, your chances of response are less than 5%. For Clozapine, D2 blockade is not the limiting factor and there the point of futility expresses a concept that going beyond this is unlikely to convert this non-responder into a responder. But the idea is more is not always better. Even if they tolerate it, you may just be wasting the patient's time. And we really wanted to get people out of that mindset that, "Well, they're tolerating it, I should give them more." Yes, up to a point. And then we call that point the point of futility.