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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 135. Go back in thread:
Posted by linkadge on January 6, 2007, at 16:26:37
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by laima on January 6, 2007, at 15:29:53
>And I keep mulling over my experience with the >prima-donna psychiatrist who genuinely believed >that if I felt zyprexa was making me feel >bizarre, it was evidence of a developing >psychosis and indicated that I needed even MORE. >Meanwhile, I noticed she had a zyprexa pen and >notepad.
Wow, thats intense. I can see the Lilly representitive trying to explain that one. "Well sometimes people on Zyprexa claim that the drug makes them feel wierd, this is a sign that the individual is indeed psychotic, and needs more medication".
"Might you be tempted if you lived on the street and had no money for the homeless shelter or for food?"
Exactly, then you're homless, and you're on potent antipsychotics, not a good combination. Nothing peps up an interview like Haldol.
Linkadge
Posted by med_empowered on January 6, 2007, at 16:47:35
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by linkadge on January 6, 2007, at 16:26:37
I think neuroleptics are pretty bad drugs. I read somewhere (maybe david healy?) that if neuroleptics hadn't yet been invented by now, there would be no need to invent them. The drugs "aren't perfect" because the side effects (movement disorders, sedation, lethary, akathisia, dysphoria, cognitive impairment) are simply a part of the main action. These aren't unintended or preventable side effects--this is what happens when you consistently block 60% or more of someone's d2 receptors. Also, I fail to see how numbing someone up for years and years is "therapeutic".
I'll be honest--sometimes, when I was freaking out, a low-dose atypical helped. It didn't save me, but it helped. But that's very low-dose,and very short-term. We're talking about keeping people on these drugs indefinitely, even though the side effects of the old ones are known, and the side effects of the atypicals are beginning to appear similar to the old ones (plus the fine side effects of massive weight gain and diabetes. woo hoo!)
Also, it strikes me as odd that (in the US at least) minorities (especially african americans) and poor people are more likely to receive a DX of "schizophrenia" than are white or non-poor patients with similar symptoms. Also, even though African Americans are often "poor metabolizers" of neuroleptics and therefore should be given less, they are often prescribed stronger neuroleptics in higher dosages for longer periods of time. Not surprisingly, African American psychiatric patients are more likely than their white counterparts to suffer from tardive dyskinesia. "Schizophrenia" is a label that can easily be used to discredit and dismiss someone, especially if that someone is poor and/or non-white. Neuroleptics are a great way to imprison people's minds when the law won't let you imprison their bodies (which, considering the huge prison population in the US, isn't all that hard to do, either).
Posted by ed_uk on January 6, 2007, at 16:51:32
In reply to Re: Patient paid to accept neuroleptic depot injection, posted by laima on January 6, 2007, at 15:29:53
>Might you be tempted if you lived on the street and had no money for the homeless shelter or for food?
No! I've taken APs before (as tablets) and they made me feel so incredibly awful I would do anything to avoid them!
Ed
Posted by fca on January 6, 2007, at 17:03:18
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 16:20:57
I have spent thousands of hours with 100s and 100s of persons with schizophrenia over the last 40 years. The progress is nothing less than remarkable in terms of their ability to live independently, maintain meaningful personal relationships, work, etc. And this is due primarily to improvements in APs. I would encourage you to spend time (and I do not mean 2 hours or a 10 day visit) but real time with persons at different points in their recovery(or stabilization) from schizophrenia. Of course a number do not want to take medicine--it has side crappy effects, sometimes it does not work and the illness itself causes mistrust and noncompliance. I am sorry for the strength of my response but I am constantly amazed and gratified by the progress that has been made. Schizophrenia is a devastating illness and I saw it when the meds were primitive and people led terribly compromised lives both inside and out of hospitals . Of course it easier for society if people are med compliant--it's also better for society if people were not addicted to alcohol and drugs. But in both cases the ultimate victims are the sufferers themselves. Finally, there is so much physical evidence (CAT scans, MRIs, PETs)that each major decompensation is a physical assault on the brain that minimizing the intensity and length of the acute decompensation is very important. Meds, while not preventing decompensation, due mitigate the damage done. Thanks for your patience fca
Posted by fca on January 6, 2007, at 17:18:22
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by med_empowered on January 6, 2007, at 16:47:35
Numbing up, TD, cognitive impairment and other side effects (not universal especially if carefully monitored)are miserable and probably are a form of prison. Please take time to seriously think about the alternatives--florid hallucinations, devastating delusions, self mutilation, total social isolation etc are not particularly desirable. I spent a lot of time with people with schizophrenia when drugs were brand new--a ward with 30 active delusional and or hallucinating patients is bedlam and not comforting for anyone--particularly the patients. TD is awful, and I mean awful--but I ask you to compare it to what persons experienced before the APs. ECTs that did not work, insulin therapy which did not work, rapid progressive organic brain damage, hours/days in isolation rooms. One can say that we should have spent enough so the institutions were humane and sensitive. Couldn't happen and wouldn't happen. Set aside politics and limited resources there is noting humane or caring about living with florid schizophrenia. You have to be tired of an old man's ranting.. Thanks Again
Posted by SLS on January 6, 2007, at 17:51:40
In reply to Re: Patient paid to accept neuroleptic depot injec » SLS, posted by ed_uk on January 6, 2007, at 13:22:54
Hi Ed.
> I know someone on Clopixol depot (zuclopentixol). Even though he has little awareness of most things (!),Can you be more specific in your description? Is it your guess that this is the result of the illness or of a neuroleptic-facilitated cognitive deficit?
> he does know that the depot makes him feel very restless. Given his mental state, it seems that his complaints about Clopixol have been completely ignored.
Is this the fault of the drug or the doctor?
Just as people have untoward reactions to antidepressants that are wrong for them, so, too, can this be said of neuroleptics.
Lots of drugs suck. I wasn't too happy with Prolixin when I was injected with it. Zyprexa, on the other hand, was wonderful as an anti-manic. It resolved the mania and cleared up my thinking. I was far from being a walking zombie. You could pay me to take a neuroleptic. In fact, I would appreciate it if you would pay for my next refill of Abilify.
> This is something that worries me.
Generalizations worry me.
- Scott
Posted by SLS on January 6, 2007, at 18:00:43
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 17:03:18
> I have spent thousands of hours with 100s and 100s of persons with schizophrenia over the last 40 years. The progress is nothing less than remarkable in terms of their ability to live independently, maintain meaningful personal relationships, work, etc. And this is due primarily to improvements in APs.
This has been my observation as well.
> Finally, there is so much physical evidence (CAT scans, MRIs, PETs)that each major decompensation is a physical assault on the brain that minimizing the intensity and length of the acute decompensation is very important.
Yes. The schizophrenic episode itself is neurotoxic.
- Scott
Posted by linkadge on January 6, 2007, at 18:13:06
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by fca on January 6, 2007, at 17:03:18
>And this is due primarily to improvements in APs.
I don't think there is conclusive evidence that atypical antipsychotics are any more effective, have fewer side effects, or are better at treating negative symtpoms as compared to conventional AP's.
A number of large studies have found no clear advantage of atypicals over conventional AP's. For instance, this study of 12,640 patients found no evidence of superiority.
http://www.bmj.com/cgi/content/full/321/7273/1371
>I am sorry for the strength of my response but I >am constantly amazed and gratified by the >progress that has been made.I don't know what progress has been made. The atypicals may be slightly more tollerable, but do not have proven superiority. They are also more likely to cause metabolic problems, which might not show up in the short term. Atypicals have not been around long enough to know the true indidence of TD. So, you are really just trading side effects.
A good percentage of patients quit their medications and lie about compliance. When I was in the hospital, for instance, I "cheeked", my seroquel, then spat it down the drain. I lied about improvement, and faked a reduction in symptoms just so I could get out. If I can do it, so can others.
>Meds, while not preventing decompensation, due >mitigate the damage done.
Do you have any references for this? For instance, there was some intial speculation that antidepressants reduced the damamge done by depressive episodes, but new evidence suggests there is no such protective effect. In a number of studies, antidepressants exaserbate the effects of stress on hippocampal morphology.
AP's can induce cumulative exposure damamge, perhaps through an increase in oxidative stress. It is thought that TD is a result of oxidative stress. People with schizophrenia are already known to have decreased antioxidant defenses and may be even more susceptable to such dammage.
Cognitive deficits induced by antipsychotics are not just due to monoamine disrupting effects. They may too be a result of increased oxidative stress.
Pathological changes in the postmortem brain of schizophrenics also have been reported in the medical literature, from exposure to antipsychotics, as compared no nonexposue. Unbiased, healthy animal studies also show brain morphology dependant on exposure duration. Many antipsychotics also downregulate BDNF, a molecule critical for the survival, growth and maintainance of new brain cells.
A quote from:
http://www.hdlighthouse.org/treatment-care/treatment/drugs/related/updates/0061risperidone.php
Dr. Sahebarao P. Mahadik (left) and Dr. Alvin V. Terry Jr. University of Georgia and the Medical College of Georgia.
"You give them a dose of haloperidol, you study receptors in their brain, you see that they block dopamine receptors so they don't have as many psychotic outbursts. Patients are quiet, docile and more easily managed … but their cognition becomes impaired, and it's worse than it would have been without treatment."
Another study:
Costly Schizophrenia Drugs No Better Than Older Generic:
http://health.dailynewscentral.com/content/view/1654/63
Also, taken from:
http://www.bmj.com/cgi/content/full/329/7474/1058
However, recent critiques have shown that recovery and readmission rates in schizophrenia before 1950 were no different7 and that antipsychotic agents might even do more harm than good.8 Thus the marked decline in the numbers of patients in asylums, from the mid-1950s (in the United Kingdom from some 150 000 in 1956 to under 40 000 in 1990) is usually attributed, at least in part, to effects of the medication. But this decline could equally be seen as socially generated via fiscal policies and community care programmes.8 Enhanced biological vulnerability to psychotic relapse might even be a result of the brain being made supersensitive to dopamine,9 medication thus acting as a double edged sword, relieving the symptoms of illness but creating an increased potential for relapse once drugs are discontinued.
Linkadge
Posted by med_empowered on January 6, 2007, at 18:25:42
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:13:06
I seem to recall seeing studies from as early as the laste 50s and early 60s (back when "antipsychotics" were being called "ataractic" drugs") that showed, even then, that the drugs weren't helpful.
I'm not anti-drug per se, but I do think we have to be careful about the drugs we go around spraying people with. Antipsychotics have a pretty long history of causing bad side effects. I can see how giving someone who is psychotic a neuroleptic, especially if you conceive of acute schizophrenic psychosis as a psychosis-heavy form of Bipolar Mania, as some have suggested. Do it short term, minimize discomfort, stop the episode, prevent too much long term damage from their actions. But months and years of this stuff? It seems ill advised. Very, very ill advised.
If someone must be medicated in schizophrenia (and a lot of people seem to do fine, over time, w/o meds), there are other meds. Try the anticonvulsants. Use benzos. Maybe even give good 'ole placebo a whirl. Opiates may be effective. But neuroleptics? To say that the "only" drugs effective for schizophrenia have "unfortunate side effects" is inaccurate. There are other meds to use--they may not be specifically "antipsychotic," but there are indications that they work on some symptoms in a good number of patients. I think the problem isn't trying to medicate some of the symptoms of schizophrenia, at least for a while--that can actually give patients and families a needed break from active psychosis--I think the problem is that the meds being used (D2 blockers) tend to be unpleasant and carry unpleasant and unwanted side effects.
Posted by linkadge on January 6, 2007, at 18:26:04
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 18:00:43
>Yes. The schizophrenic episode itself is >neurotoxic.
I would suggest that the drugs are more neurotoxic.
People have used the argument that depression is more toxic than antidepressants, but data suggests that no such protective effect on antidepressants exist. (tianeptine is an exception.)
We know from animal studies that the drugs are neurotoxic, we also know that AP's do not fix or halt the underlying disorder. So you are taking a damaging drug that does not necessarily halt the underlying disease progression.
The data on conventionals is fairly conclusive to indiacate brain dammage. I don't think the typicals have been around long enough to suggest that they halt the disease.
Linkadge
Posted by linkadge on January 6, 2007, at 18:29:11
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by med_empowered on January 6, 2007, at 18:25:42
I think you'd see a better long term outcome with vitamin C, and Niacin.
Linkadge
Posted by fca on January 6, 2007, at 18:39:15
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:13:06
spend more time on this--I have lived with this for so long perhaps I am blind to the other side. I really do not want to spend more time researching it or debating it. I am confident that science and the lives of 100s of thousands are on my side. I know this is an unfair tactic but I need to move on. Like you, I am not sure whether the newer atypicals are better for many but I know for a fact that almost 1/3 of persons with schizophrenia who never responded to any treatment now have a realistic chance of improving. If you wish, start researching the PET studies done before and after serious periods of decompensation. Or better yet go back and look at the mortality and morbidity statistics for people with schizophrenia who were alive 50-70 years ago before any of the major antipsychotics. I would guess that most were dead by their mid fifties and/or had such overwhelming cognitive limitations that they were essentially unable to function. People with schizophrenia still have a much shorter life span than others but I bet it sure is longer than before. Sorry for aborting the debate because it is worth having. Taking the dog for a short run and then popcorn and a DVD. fca
Posted by Phillipa on January 6, 2007, at 18:57:52
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 11:08:45
How do you recover from schizophrenia without some sort of med? And maybe the payment would allow some of them to not have to live in a shelter. And doesn't true schizophrenia show up on MRI's? Love Phillipa
Posted by Phillipa on January 6, 2007, at 19:09:01
In reply to the case for neuroleptics is kind of weak, posted by med_empowered on January 6, 2007, at 11:50:21
Med seriously when clozapine first came out I saw miracles in patients that did not respond well to other neuroleptics or had things like bladder reactions. And with cogentin etc. many side effects of the older antipsychotics were completed avoided. I belive it was before a med like akentin or cogentin was available that most of the TD or dystonia resulted. My opinion based on what I saw. But I did see nonfunctional people go out and get jobs, get married. And had a very good quality of life. Love Phillipa
Posted by ed_uk on January 6, 2007, at 19:18:59
In reply to Re: Patient paid to accept neuroleptic depot injec » ed_uk, posted by SLS on January 6, 2007, at 17:51:40
Hi Scott
>Is it your guess that this is the result of the illness or of a neuroleptic-facilitated cognitive deficit?
I think it is the result of his illness.
>Is this the fault of the drug or the doctor?
The doctor.
What concerns me is that drugs with a high incidence of side effects (eg. depots) are being given to patients who may not be capable of reporting or expressing their side effects to the prescriber. In some cases, continued administration of medication results despite serious side effects.
>In fact, I would appreciate it if you would pay for my next refill of Abilify.
I'm sure :) They certainly make a huge profit on the atypicals.
Ed
Posted by Phillipa on January 6, 2007, at 19:21:14
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by laima on January 6, 2007, at 15:28:24
Except if truly psychotic money is not something they are even aware of they just want the symptoms of voices tv talking to them, spiritual warfare in the minds to go away. A lot go off their meds to sell them for money. And it takes quite a while for the symptoms to abate as they tend to make the patient extremely tired. Also very poor hygiene creates other problems as well. Love Phillipa
Posted by linkadge on January 6, 2007, at 20:59:15
In reply to Linkadge. to late in the evening to, posted by fca on January 6, 2007, at 18:39:15
>I know this is an unfair tactic but I need to >move on.
No worries.
>but I know for a fact that almost 1/3 of persons >with schizophrenia who never responded to any >treatment now have a realistic chance of >improving.I am not saying that antipsychotics may not produce some impressive short term changes in behavior in schizophrenics, but that is far from proof of helping them long term.
>If you wish, start researching the PET studies >done before and after serious periods of >decompensation.
We could also look at post mortem neuroleptic induced morphological alterations in brain structure.
>Or better yet go back and look
>at the mortality and morbidity statistics for >people with schizophrenia who were alive 50-70 >years ago before any of the major antipsychotics.I was under the impression that antipsychotics increased morbidity. If you are referring to suicide risk, clozapine is the only antipsychotic with any proven effect on suicide rate.
>I would guess that most were dead by their mid >fifties and/or had such overwhelming cognitive >limitations that they were essentially unable to >function.There are many studies that show that *long term* neuroleptic use worsens cogntative function in schizophrenia.
Time Dependent Cognitive Deficits Associated with First and Second Generation Antipsychotics: Cholinergic Dysregulation as a Potential Mechanism
http://jpet.aspetjournals.org/cgi/content/abstract/jpet.106.106047v2
Evidence of neuroleptic induced brain dammage:
http://www.namiscc.org/Research/2003/NeurolepticInducedBrainDamage.htm
Dramatic downregulation of BDNF following Haldol treatment.
The Effect of Antipsychotics on Cognition in Schizophrenia
http://www.cnsforum.com/magazine/focus/cognition_schizophrenia/
"Neuroleptics were associated with the reduction of psychotic symptoms of schizophrenia, but they did not demonstrate any significant impact on cognitive features of the disease (Sweeney et al., 1991)."
"Conventional antipsychotics, which primarily block D2 dopamine receptors, may demonstrate no effect (Berman et al., 1986) or minimal beneficial effect on cognitive functioning (Serper et al., 1994) or can even further impair cognitive functioning (Sweeney et al., 1991). Also, traditional antipsychotics cause extrapyramidal symptoms (EPS), which significantly decrease speed on cognitive tasks involving motor output and readiness to respond."
"Acute treatment with typical neuroleptics can result in a deterioration in some aspects of attention and motor behavior"
"neuroleptic drugs lack the ability to improve the various domains of cognitive function impaired in schizophrenia."
>People with schizophrenia still have a much
>shorter life span than others but I bet it sure
>is longer than before."However, it is possible that the impact of adverse effects on the cardiovascular system related to certain antipsychotic drug use may well increase the prevalence of mortality and morbidity due to cardiovascular events and may also play a significant role in the reduced life expectancy of the patient with schizophrenia"
Linkadge
Posted by linkadge on January 6, 2007, at 21:02:44
In reply to Re: the case for neuroleptics is kind of weak » med_empowered, posted by Phillipa on January 6, 2007, at 19:09:01
>And with cogentin etc. many side effects of the >older antipsychotics were completed avoided
Cogentin simply blocks the symptomatic expression of TD. There is no evidence that it blocks the morphocological changes that resulting from AP's that cause dyskinesias to progress.
Its just like how they can help parkinsons, but they do nothing to slow the progression of parkinsons.
Linkadge
Posted by linkadge on January 6, 2007, at 21:14:01
In reply to Re: the case for neuroleptics is kind of weak, posted by linkadge on January 6, 2007, at 21:02:44
You are saying that you've AP's must be good because you've seen so many patients improve on them.
Well, lets think back to the early days of L-dopa usage. A Parkinson's patient was brought out on stage, shaking, perhaps in a wheelchair. He was then taken backstage and administered l-dopa. The patient then walks back in, dances around, plays the piano etc.
To the untrained observer, l-dopa was the cure.
It wasn't till later that researchers realized that l-dopa was actually speeding the progression of the illness, and enhancing dopaminergic cell loss in movement areas of the brain.
So, I would argue that it is necessary to look very long term, to see if these drugs are really benifitting the patients.
Whats the point of winning a battle if you loose the war?
Linkadge
Posted by laima on January 6, 2007, at 22:22:01
In reply to Re: Patient paid to accept neuroleptic depot injec » linkadge, posted by Phillipa on January 6, 2007, at 18:57:52
Fish oil? Vitamins? Stress relief, social support? Therapy? Quit illegal drugs? Excercise and good diet?Not even clear anymore if there is a such thing as "true schizophrenia" per the most up to date reports--they argue it's more of an umbrella term.
> How do you recover from schizophrenia without some sort of med? And maybe the payment would allow some of them to not have to live in a shelter. And doesn't true schizophrenia show up on MRI's? Love Phillipa
Posted by laima on January 6, 2007, at 22:23:38
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Phillipa on January 6, 2007, at 19:21:14
They go sell their antipsychotic drugs somewhere? Who on earth buys that stuff?> Except if truly psychotic money is not something they are even aware of they just want the symptoms of voices tv talking to them, spiritual warfare in the minds to go away. A lot go off their meds to sell them for money. And it takes quite a while for the symptoms to abate as they tend to make the patient extremely tired. Also very poor hygiene creates other problems as well. Love Phillipa
Posted by Phillipa on January 6, 2007, at 22:27:25
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by laima on January 6, 2007, at 22:22:01
Laima problem as I would see it with fish oil etc is that they would be paranoid to take them. Maybe first take it in steps. Eleviate the paronoia and say when it's gones off the antipschotics and lets try vitamins? I have a schizophrenic person I e-mail with who love haldol, lithium and anafranil I'll ask him what he thinks about your idea okay? Love Phillipa
Posted by Phillipa on January 6, 2007, at 22:30:10
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by laima on January 6, 2007, at 22:23:38
Someone posted that people in jail were snorting seroquel horrible. But that's evidently going on too. Love Phillipa
Posted by Quintal on January 6, 2007, at 22:38:32
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by laima on January 6, 2007, at 15:19:33
>And I keep mulling over my experience with the prima-donna psychiatrist who genuinely believed that if I felt zyprexa was making me feel bizarre, it was evidence of a developing psychosis and indicated that I needed even MORE. Meanwhile, I noticed she had a zyprexa pen and notepad.
I had that exact experience with a cocky new psychiatry graduate who tried to tell me Zyprexa was a regular antidepressant like Prozac. When I corrected him he asked me how I knew that olanzapine was the generic name despite the fact that it was written in plain view on his desk top jotter and coffee mug. I did eventually take it and he refused to believe that 5mg was making me feel spaced out and drowsy. He also thought Zyprexa would cause no significant impairment in driving performance even if taken in the morning.
I'm believing ever more strongly that they should really think about taking some of these drugs themselves before making comments like that.
Q
Posted by yxibow on January 6, 2007, at 22:38:40
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:29:11
> I think you'd see a better long term outcome with vitamin C, and Niacin.
>
> LinkadgeMy experience with time release Niacin has been less than stellar -- the idea of low flush did not work, it did not solve any anxiety, in fact it generated more and flushing. But as they say, your miles may vary.
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Dr. Bob is Robert Hsiung, MD,
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