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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 49. Go back in thread:
Posted by linkadge on June 7, 2007, at 19:13:23
In reply to Re: The right to non-compliance » linkadge, posted by Squiggles on June 7, 2007, at 16:35:42
Not to dismiss your case, but both me and my mother got that same batch you are talking about in canada.
Everbody reacts differently, but we didn't notice any difference.
Linkadge
Posted by linkadge on June 7, 2007, at 19:20:25
In reply to Re: The right to non-compliance » linkadge, posted by Squiggles on June 7, 2007, at 16:42:32
>I'm not sure that withdrawal can be so sudden >though, for suicide.
Withdrawl from antidperessants can happen after the first dose! Lilly probably took her down from like 200mg to 0 in a day or two.
>I can't say for sure I know what was going on >pharmacologically. One things seems sure though, >and from a clinical point of view, relevant to >one's health-- discontination is risky.But people can make their own decisions. This isn't THX-1138. If people don't want to be on drugs, and they want to off themselves, so what? Its their life.
If life on the drugs was honestly better, then they'd stay on the drugs, thats my take. People usually come off the drugs because they're not working, or that they feel better off them.
If I was to off myself, I don't think drugs would make a difference. Infact the times that I came closest was when I was on these drugs. Lithium is one of the only drugs that has any proven antisuicide effect, the case for other drugs is highly equivocol.
>As for the greedy pharm companies- all >corporations are greedy- that's why we have the >FDA.
Yeah, well I don't think much of them either.
Linkadge
Posted by linkadge on June 7, 2007, at 19:22:35
In reply to Re: The right to non-compliance » linkadge, posted by Squiggles on June 7, 2007, at 16:42:32
The case for these drugs is so weak! Perhaps they'd have better luck forcing people to take placebos, both from the standpoint of efficacy and tollerability.
Linkadge
Posted by Squiggles on June 7, 2007, at 19:26:09
In reply to Shades of Grey? » Squiggles, posted by Quintal on June 7, 2007, at 18:16:20
Agreed -- though generalizations apply to
all cases, and that may be a mistake.Squiggles
Posted by linkadge on June 7, 2007, at 19:27:20
In reply to Shades of Grey? » Squiggles, posted by Quintal on June 7, 2007, at 18:16:20
I think that even people with psychotic disorders diserve the right to make their own decisions about medications.
Where would we be if people like John Nash were forced to take medications?
In addition, the rates of remission for things like Schizophrenia are higher in some less developed countries where medications are scarcely prescribed.
I think fewer drugs would probably lead to more recoveries. In a lot of cases, medications hinder recovery.
Linkadge
Posted by Squiggles on June 7, 2007, at 19:30:28
In reply to Re: Shades of Grey?, posted by linkadge on June 7, 2007, at 19:27:20
You may think this outrageous, but after
reading his bio, i just got the feeling that
John Nash never had any psychiatric disorder,
except perhaps being in the Asperger's spectrum
early on. I think he made it up to pursue his
passion.Squiggles
Posted by Bob on June 7, 2007, at 19:30:48
In reply to Re: The right to non-compliance, posted by linkadge on June 7, 2007, at 19:20:25
> >I can't say for sure I know what was going on >pharmacologically. One things seems sure though, >and from a clinical point of view, relevant to >one's health-- discontination is risky.
>
> LinkadgeI second every word of what Linkadge says there. He's making some awfully good points. Indeed, if these drugs were so tolerable and effective, they truly would be making feel better, and there wouldn't be a constant insidious drive to get off of them. I too never came closer to suicide than when discontinuing a drug. Unfortunately, it seems I need to continue with the miserable compromise of a life on psychotropics.
Posted by linkadge on June 7, 2007, at 19:42:37
In reply to The Role of Pharmaceutical Companies............., posted by Quintal on June 7, 2007, at 18:30:21
Posted by linkadge on June 7, 2007, at 19:44:49
In reply to Re: Shades of Grey? » linkadge, posted by Squiggles on June 7, 2007, at 19:30:28
I read the book. I don't see how Nash could have made something like that up.
Didn't he undergoe ETC?? I don't think Nash would risk his brain in such a way if there wasn't something there.
Just because somebody gets better without drugs doesn't mean their illness wasn't genuine.
Linkadge
Posted by Squiggles on June 7, 2007, at 21:04:17
In reply to Re: Shades of Grey? » Squiggles, posted by linkadge on June 7, 2007, at 19:44:49
> I read the book. I don't see how Nash could have made something like that up.
Not necessarily malingering but crashing;
>
> Didn't he undergoe ETC?? I don't think Nash would risk his brain in such a way if there wasn't something there.
>
NO! His wife ordered the drs. not to mess
with his "beautiful mind". He went to live
with her after he tired of the hospital, as you may recall in the book.
> Just because somebody gets better without drugs doesn't mean their illness wasn't genuine.True, but whatever it was, it was transient.
I doubt that is the case with clinical depression
and manic-depression.Squiggles
Posted by linkadge on June 8, 2007, at 6:42:33
In reply to Re: Shades of Grey? » linkadge, posted by Squiggles on June 7, 2007, at 21:04:17
>True, but whatever it was, it was transient.
>I doubt that is the case with clinical depression
>and manic-depression.A single episode of clinical depression rarely lasts longer than 8 months. Nash was out of it for longer than that.
And like I said in previous posts, the recovery rate for shizophrenia is higher in some less developed countries where antipsychotics are not used.
So there is not a doubt in my mind that this may not have been shizophrenia or some other serious mental illness that improved over time.
Linkadge
Posted by linkadge on June 8, 2007, at 6:45:17
In reply to Re: Shades of Grey?, posted by linkadge on June 8, 2007, at 6:42:33
According to:
http://www.namiscc.org/newsletters/February02/JohnNashDrugFreeRecovery.htm
But as Sylvia Nasar notes in her biography of Nash, on which the movie is loosely based, this brilliant mathematician stopped taking antipsychotic drugs in 1970 and slowly recovered over two decades.
So he did take them for a point, and he didn't recover over night.
Linkadge
Posted by linkadge on June 8, 2007, at 6:46:49
In reply to Re: Shades of Grey?, posted by linkadge on June 8, 2007, at 6:42:33
Also:
From the same link:
His is just one of many such cases. Most Americans are unaware that the World Health Organization (WHO) has repeatedly found that long-term schizophrenia outcomes are much worse in the USA and other "developed" countries than in poor ones such as India and Nigeria, where relatively few patients are on antipsychotic medications. In "undeveloped" countries, nearly two-thirds of schizophrenia patients are doing fairly well five years after initial diagnosis; about 40% have basically recovered. But in the USA and other developed countries, most patients become chronically ill. The outcome differences are so marked that WHO concluded that living in a developed country is a "strong predictor" that a patient never will fully recover
Linkadge
Posted by Squiggles on June 8, 2007, at 6:53:25
In reply to Re: Shades of Grey?, posted by linkadge on June 8, 2007, at 6:42:33
....
> A single episode of clinical depression rarely lasts longer than 8 months. Nash was out of it for longer than that.
>But it comes back through the lifetime.
>
> And like I said in previous posts, the recovery rate for shizophrenia is higher in some less developed countries where antipsychotics are not used.
>
Well, i'm really not sure about that. It sounds like a loaded argument. Why would that be? Is it the poverty, the social isolation, the lack of understanding of what mental illness is, the diseases, the lack of doctors and especially *psychiatric medication* or just an argument used by anti-psychiatry?
> So there is not a doubt in my mind that this may not have been shizophrenia or some other serious mental illness that improved over time.He did have periods of strange ideas-- that could just have been a breakdown, and not schizophrenia. I think Asperger's or high functioning autism is closer to the description of his life, and very common in brilliant men and women. But of course, that is a guess, and the recovery is the key. I know of no schizophrenics who recover from this disease without constant medication, and that is not a recovery per se.
Squiggles
Posted by Squiggles on June 8, 2007, at 7:12:28
In reply to Re: Shades of Grey?, posted by linkadge on June 8, 2007, at 6:46:49
I'm not sure how reliable statistics are
in poor countries, or even diagnoses. I'll
have to look at at the WHO report on this--
any links to it to save me searching the wrong
places?Squiggles
Posted by Squiggles on June 8, 2007, at 7:20:59
In reply to Re: Shades of Grey?, posted by linkadge on June 8, 2007, at 6:46:49
If that is the case, personally i would rather
live medicated in Canada, than recovered in
Nigeria.Squiggles
Posted by Squiggles on June 8, 2007, at 7:51:39
In reply to Re: Shades of Grey? » linkadge, posted by Squiggles on June 8, 2007, at 7:20:59
Take a look at the ratio of psychologists to the population (the Wikipedia article), on
mental health stats in Nigeria, as an example
(there are much poorer counries):"Mental health
The majority of mental health services is provided by 8 regional psychiatric centers and psychiatric departments and medical schools of 12 major universities. A few general hospitals also provide mental health services. However, the formal centers have competition in native herbalists and faith healing centers.
The ratio of psychologists and social workers is 0.02 to 100,000.[6]"
And BTW, the herbalists and alternative psych practitioners, have move in to fill in the medical gap.
In Canada there are 2.14 physicians per 1000 people. Poor countries aspire to a better health care system if they can afford it.
http://en.wikipedia.org/wiki/Health_care_in_Canada#Canadian_health_care_in_comparison
Squiggles
Posted by Squiggles on June 8, 2007, at 9:33:22
In reply to Re: The right to non-compliance » linkadge, posted by Bob on June 7, 2007, at 19:30:48
> > >I can't say for sure I know what was going on >pharmacologically. One things seems sure though, >and from a clinical point of view, relevant to >one's health-- discontination is risky.
> >
> > Linkadge
>
>
>
> I second every word of what Linkadge says there. He's making some awfully good points. Indeed, if these drugs were so tolerable and effective, they truly would be making feel better, and there wouldn't be a constant insidious drive to get off of them. I too never came closer to suicide than when discontinuing a drug. Unfortunately, it seems I need to continue with the miserable compromise of a life on psychotropics.Is the comment above made by Dr. Robert Hsiung (Dr. Bob) or another Bob?
Posted by linkadge on June 8, 2007, at 10:47:06
In reply to Re: Shades of Grey? » linkadge, posted by Squiggles on June 8, 2007, at 6:53:25
People with aspergers don't believe they are being contacted by space aliens.
Linkadge
Posted by linkadge on June 8, 2007, at 10:49:16
In reply to Re: Shades of Grey? » linkadge, posted by Squiggles on June 8, 2007, at 7:20:59
>If that is the case, personally i would rather
>live medicated in Canada, than recovered in
>NigeriaBut the point is to ask the question of why this difference occurs.
There have also been studies showing that medication with antidepressants prolongs the course of the illness making it more chronic.
Linkadge
Posted by Squiggles on June 8, 2007, at 11:21:55
In reply to Re: Shades of Grey? » Squiggles, posted by linkadge on June 8, 2007, at 10:49:16
I have searched for evidence that lack of medical care is good for mental illness, and have found none. Personally, i find such a proposition absurd. Show me some articles on this.
See this:
Posted by Quintal on June 8, 2007, at 11:30:31
In reply to Re: Shades of Grey?, posted by linkadge on June 7, 2007, at 19:27:20
Certainly I think people who have psychotic disorders should have a say in their treatment (or lack thereof), but I've found through experience that there's sometimes a need for enforced medication and/or hospitalisation during crises. I looked after a friend who has Schizophrenia while her parents were away and it was a harrowing experience.
My friend started having paranoid delusions about her parents - that they'd been keeping her son (who died when she was 18) in hiding from her while conspiring with doctors to feign the death because they thought she was an unfit mother. There were many variations on this theme and most of the time she was incoherent and inconsolable with grief and rage. It was during one of these rages that she slammed her fist into a photo of her mother cutting herself badly. In the end I had to ring the doctor and ask for his advice because I couldn't cope any more after a few days with hardly any sleep (she kept doing other dangerous things like leaving the house in the night, and she had a habit of lying down in the road near where she lives - ostensibly because she could hear the breathing of a dying animal in the Earth, but I suspect she knew the risk and was trying to attempt suicide). Anyway, the doctor called an ambulance and we managed to get her into hospital under the premise of treating the injured hand, but of course she was kept under suicide watch on the psychiatric ward once she got there.
That was about three years ago and after that episode she was Zyprexa for a while. Last summer she gave birth to a baby girl after being medication free for a year (though she did have a relapse during the pregnancy). She seems to be doing fine now as a full-time mother without medication. Maybe she really needed the distraction and focus of having a child to fill the void left by the one she lost all along? It was never fully concluded whether she had Schizophrenia or recurring psychotic depression triggered by the loss of her first child, but when pressed her psychiatrist diagnosed Paranoid Schizophrenia. Things aren't that simple though.
She was shocked and remorseful about her behaviour during the psychotic episode, and agreed she did need to be hospitalised for her own safety. I think she actually was frightened by how she lost control of her mind and the risks she'd taken. So on that basis I think medication during a crisis helps the patient and the family cope (they also used large doses of lorazepam, not just Zyprexa, to calm her because she was so afraid and I think that really gave her some comfort). To me, simply letting people in my friend's position have complete freedom in their actions could amount to neglect. For example, would it be wise to allow an elderly relative who had senile dementia to wander the streets and roads alone at night if they so wished, out of respect for their personal freedom? Which should we respect more - their right to act on their own volition or their right to safety and care? That's what I mean when I say people who have psychotic disorders are more vulnerable and the decision to discontinue their meds needs extra care than the depressive who has never had a psychotic episode or attempted suicide.
I agree that while antipsychotic medication controls symptoms during a crisis, it usually prevents a full recovery when taken long-term. That's why I think it's important to allow people with psychotic disorders to come off medication if that seems prudent with regards to their history, circumstances and environment.
Q
Posted by Squiggles on June 8, 2007, at 12:12:54
In reply to The Right to Non-Compliance in Psychotic Disorders, posted by Quintal on June 8, 2007, at 11:30:31
How sad. Mental breakdowns are terrible.
I am glad you posted this-- I agree that
the dx is hard in psychotic episode - i think
the drug if working may prove what it is more or
less. I also agree that if the person is getting
sick from the drugs they should be give a chance to
switch or stop for a while, or reduce the dose...
BUT only under supervision. And i think that supervision is not generously provided in mental health care-- it's expensive and time-consuming.Squiggles
Posted by Quintal on June 8, 2007, at 15:15:58
In reply to Re: The Right to Non-Compliance in Psychotic Disor » Quintal, posted by Squiggles on June 8, 2007, at 12:12:54
My friend was living in sheltered accommodation with her boyfriend during her pregnancy so yes she was under close supervision. Unfortunately her boyfriend is Schizophrenic and heavily medicated - they met in a psychiatric ward. Sometimes I fear for the child's future because he's very manipulative, a drug addict and he's also been violent towards my friend. I don't think he could look after his daughter properly (and I'm not sure he would even if he could), so if my friend has another relapse....... what an awful upbringing it could be. Hopefully the grandparents and social workers would step in to smooth things out (they both have a team of social workers and psychiatric nurses, along with other personnel looking after them).
Q
Posted by Squiggles on June 8, 2007, at 15:22:45
In reply to Re: The Right to Non-Compliance in Psychotic Disor » Squiggles, posted by Quintal on June 8, 2007, at 15:15:58
That's good. The situation is very delicate
and stressful for all, i'd think.
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Dr. Bob is Robert Hsiung, MD,
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