Posted by med_empowered on July 27, 2005, at 3:44:25
In reply to Re: yup » med_empowered, posted by alexandra_k on July 26, 2005, at 22:07:36
hey! Yeah, there is some indication that pre-neuroleptic era asylums reported TD-like movements in those who were admitted. There are some problems with this however. First of all, TD type movements (and schizophrenia-type symptoms) often occur during or after a bout of encephalitis lethargica, which apparently was something of a problem around the same time the very term "schizophrenia" was coined and described in the literature. Secondly, its important to keep in mind that antipsychotics have never been used only for psychosis. Thorazine was originally developed as a pre-operative sedtive; it worked so well, and resulted in "sedation without necrosis," so the decision was made to give Thorazine (and later resperine) to inmates in asylums...not so much to cure them per se as to calm them down. Keep in mind that Deniker, et. al, the early pioneers in neuroleptic research, compared the effects of Thorazine to "a chemical lobotomy". Until about 1964, Thorazine truly was used as a "tranquilizer," not an "antipsychotic". Its "antipsychotic" effects were attributed to its unusual sedative powers. As such, Thorazine was used in all kinds of disorders. It was used in lower doses for depression, anxiety, "senile agitation", control of the behavior of the mentally handicapped, in prisons and orphanages...so on and so forth. It also was used, and is used, as an anti-emetic and in part of anaesthesia mixes (ex: DPT--Demerol, Promethazine, Thorazine; this is used alot in children, apparently). The problem with claiming that neuroleptics only slightly raise the TD risk is that no one ever recorded how often TD-like movements presented themselves in those with schizophrenia who did not take neuroleptics, and no one ever did such a study that controlled for other conditions, such as encephalitis lethargica. The numbers I quoted--20% over 5 years--come from the 1980 American Psychiatric Association Tardive Dyskinesia Taskforce. At the time, shrinks were getting sued left and write, especially in the US (apparently, US shrinks tended to use larger doses of neuroleptics and use them for longer periods...European docs tended to use lower doses, sometimes did drug-holidays, and were more willing to terminate neuroleptic treatment when a patient stabilized). A lot of experts think the APA numbers are actually pretty low, since they exclude more minor cases of TD (and since docs kind of ignored TD, especially in the US, until around 1980, even though reports first appeared in the literature around 1957 and the "Thorazine shuffle" was a well-known phenomenom only a short while after the widespread introduction of Thorazine into the mental health system). One thing I personally find offensive is doctors who find it unethical to "withhold" neuroleptics. Patient non-compliance with neuroleptic treatment is much, much more frequent than patients banging down doctors doors begging for more Haldol...this is why we have fast acting injections and depot injections, and why an implant was recently developed to deliver Haldol over a long period. The questions here revolve around POWER and TRUTH. Whose decision is it to decide whether TD or untreated schizophrenia is a worse fate? Whose decision is it to decide whether or not a certain individual continues to consume chemicals that fundamentally alter their thought processes and carry definite risks? To me, forcing someone to take a neuroleptic--and deciding that doing so is OK, and worth the risk of TD and other problems--basically sends the message that if you venture too far astray from what is "normal," you can and will have "normality" forced upon you, whether you like it or not. Considering the side effects--not just TD, but NMS, akathisia, "neuroleptic induced dysphoria," the "neuroleptic induced deficit syndrome," EPS, etc., it seems to me that forcing neuroleptics on people, or coaxing them against their own feelings that they *must* take them is more like PUNISHMENT than treatment. Having taken newer neuroleptics, and met those who have taken neuroleptics more long term and/or taken older ones, I can honestly say that I DO NOT think the risks of neuroleptic use are justified by "benefits". As for the TRUTH part of the equation...the truth is that, for all the "wonder drugs" (Thorazine, Haldol, down to Zyprexa and Abilify), Schizophrenia remains an incredibly disabling illness, and drugs dont seem to have made a huge dent in the problem. Those with Schizophrenia still have a freakishly high suicide rate (15% WITH treatment), they still experience severe cognitive and social impairment, and they still seem to largely lead isolated, unfulfilled lives on the margins of society. It seems that those with schizophrenia in less developed nations with stronger family and community systems recover more often and lead much better lives than those in the US...keep in mind that many of those in less developed countries are either NEVER treated with neuroleptics or they are only periodically treated while floridly psychotic. To be truly honest about neuroleptics, I think we must admit that although they have helped some people, and medications may well play a huge part in handling all the problems associated with schizophrenia, there are still many, many unanswered questions and neuroleptic treatment causes significant problems with few clear benefits.
poster:med_empowered
thread:533472
URL: http://www.dr-bob.org/babble/20050723/msgs/534087.html