![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 57. This is the beginning of the thread.
Posted by bleauberry on October 3, 2015, at 7:11:44
It angers me that psychiatric patients get such inadequate care.
Mass shooting seem to have two things in common:
1) The shooter has a poorly managed psychiatric history.
2) They choose gun-free zones for their targets.What can be done to get all patients greatly improved care?
Obviously Obamacare has failed on just about every level you can think of, and every single promise about it has been broken. But set that behind for a moment....what can we do to get patients much better care?
Most of the meds are not very good. This board would not exist if they were. Most of the treatments are not very good. This board would not exist if they were. The entire approach....throw a drug at it....seems woefully inadequate. What can we do?
Posted by SLS on October 3, 2015, at 9:18:39
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
> It angers me that psychiatric patients get such inadequate care.
>
> Mass shooting seem to have two things in common:
> 1) The shooter has a poorly managed psychiatric history.
> 2) They choose gun-free zones for their targets.
>
> What can be done to get all patients greatly improved care?
>
> Obviously Obamacare has failed on just about every level you can think of, and every single promise about it has been broken. But set that behind for a moment....what can we do to get patients much better care?
>
> Most of the meds are not very good. This board would not exist if they were. Most of the treatments are not very good. This board would not exist if they were. The entire approach....throw a drug at it....seems woefully inadequate. What can we do?Read.
- Scott
Posted by Tomatheus on October 3, 2015, at 14:40:26
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
Bleauberry,
I will address the question that you asked as to what can be done to get psychiatric patients much better care. First, I want to say that there clearly are some patients who will respond well to the psychiatric and psychological interventions that are available today. For these patients, it's important that they're made aware of their treatment options and that the treatment options themselves are accessible.
Despite the fact that many are helped by psychiatric and psychological treatments for mental illness, I also think that there are some who fall into one or more of the following categories: 1) they're not helped at all by psychiatric and psychological interventions, 2) they're helped by the currently available interventions, but to a degree that most would consider to be inadequate, and 3) their conditions are worsened by the currently available interventions. In my opinion, what needs to be done to help those that fall into any one of the three categories that I identified above is to actually improve the treatments for mental illness themselves, not to improve the quality of "care" or the access to "care."
When I first presented myself for treatment of what at the time was some sort of clinical depression more than 13 years ago, I had a good deal of confidence in my treatment providers. My therapist and psychiatrist both seemed to listen and to care about my needs, and it seemed that they would do everything that they could to help me. Unfortunately, after years of treatment, my condition mostly just worsened. Was the problem with the quality of my treatment providers or with my access to treatment? I don't think so. In my estimation, the problem had more to do with the fact that the treatments interventions that I initially accepted failed to treat my illness or even, for the most part, to reduce the severity of my symptoms. I had access to treatment, and as far as I could tell, my "care" seemed to be managed in a quality manner, but in the end, none of those things seemed to matter much for me because the treatments that I utilized were not very effective.
So, while I think that making patients aware of their treatment options and making sure that the treatment options are accessible would help the percentage of patients who will respond well to the psychiatric and psychological interventions that are currently available, I think that for patients who won't respond so favorably to the current treatments, better treatments are needed. And I think that to make better treatments, it's essential that scientists improve their understanding of the illnesses that mental health professionals are trying to treat. As far as I can tell, research that aims to better understand mental illness is ongoing, and I think that this is something that should continue to happen. Will this lead to overnight results for those who aren't being helped by psychiatric and psychological interventions? No. But I think that by better understanding mental illness, better and more individualized treatments will eventually be developed that should improve the lives of those of us who live with mental illnesses.
In the meantime, I think that those of us who have mental illnesses need to recognize that the treatments that are available to us have their limits. I also think it's important that we continue to look for treatment options when we feel that our current treatments aren't serving us well and that we embrace the treatments that do seem to help, even if they only help so much.
Tomatheus
Posted by SLS on October 3, 2015, at 16:25:35
In reply to Re: Shooters and Psychiatry » bleauberry, posted by Tomatheus on October 3, 2015, at 14:40:26
Posted by Tomatheus on October 3, 2015, at 16:44:52
In reply to Re: Shooters and Psychiatry - Very well said (nm) » Tomatheus, posted by SLS on October 3, 2015, at 16:25:35
Thank you for the support, Scott.
Tomatheus
Posted by baseball55 on October 3, 2015, at 20:01:19
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
Most of these shooters were not in the mental health system at all, so blaming the mental health system for failing them is beside the point. There are plenty of weird and angry people out there who are not mentally ill in any accepted diagnostic sense and don't seek out therapy or medication. There's no evidence this guy in Oregon ever sought help for mental illness. The only one of these many shooters that I know of who was briefly in the mental health systems was the guy in Sandyhook, whose mother was worried about him. But was he worried about himself? Enough to seek out and accept help?
Sometimes people with murderous intentions just prefer to nurse their murderous intentions. Why call them mentally ill? Politicians pull out this term because all of us assume that someone who does what they did is nuts. But there's a difference between being nuts and having a diagnosable or treatable mental illness.
People kill their girlfriends and their girlfriend's children every day and we don't bother calling them mentally ill. I suppose because they don't use assault weapons, so that we have to broach the delicate topic of gun control.
And, bleauberry, what does Obamacare have to do with anything at all? Save your political rants for the politics board.
Posted by hello321 on October 3, 2015, at 21:42:11
In reply to Re: Shooters and Psychiatry, posted by baseball55 on October 3, 2015, at 20:01:19
One idea may be to look into any possible connection
between Psychiatric Drugs and violence. To see if they could be actually inducing a state of mind in some people that leads to them becoming violent. It seems random mass homicidal acts are becoming more and more the norm. Meanwhile, more and more people are receiving psychiatric treatments.According to this site, a good amount of violent acts have been committed by folks who have taken psychiatric meds during or around the time leading up to when they became violent.
http://www.cchrint.org/school-shooters/Psychiatric meds have already been shown to induce thoughts/emotions that could be deemed as "precursors" to violence. These effects are described in a pretty general way as anxiety, inclusiveness, irritable, agitation,, hostile, aggressive, restless, hyperactive, more depressed, and new or increased thoughts of suicide (which is what often happens after the violence on others has been completed)
But basically, if there is a link between the increase in psych med use and the increase in mass violent acts, it needs to be recognized so that we can attempt to do something about it.
Posted by SLS on October 3, 2015, at 23:00:23
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 3, 2015, at 21:42:11
> But basically, if there is a link between the increase in psych med use and the increase in mass violent acts, it needs to be recognized so that we can attempt to do something about it.
I agree.
How do we know that there is an increase in mass violent acts?
- Scott
Posted by hello321 on October 3, 2015, at 23:36:47
In reply to Re: Shooters and Psychiatry » hello321, posted by SLS on October 3, 2015, at 23:00:23
Here's a website I found showing the rate of various types of crimes in the US since 1960
http://www.disastercenter.com/crime/uscrime.htmYou can compare the numbers to the population numbers shown for each year. And actually, the ratio for violent crimes has decreased a bit in recent years.
Posted by hello321 on October 4, 2015, at 0:01:34
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 3, 2015, at 23:36:47
It shows the violent crime rate in america peaked in 1991 with 758 per 100,000 people. And in 2014 it was at 375 per 100,000 people. The last time it was bow this was in 1970, with 363 violent crimes per 100,000 people. Tho the Violent crime rate is still over double what it was in the first year shown. In 1960 it was only 160 per 100,000 people in america.
Posted by Hugh on October 4, 2015, at 0:25:35
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 4, 2015, at 0:01:34
I found this article about violent crime rates fascinating:
http://www.motherjones.com/environment/2013/01/lead-crime-link-gasoline
Posted by PeterMartin on October 4, 2015, at 9:45:08
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
Right blame Obama. No. Guy tries and cares.....can't do much when half the media blames him for everything.
The problem is GUNS.
Posted by Lamdage22 on October 4, 2015, at 12:25:57
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
> Most of the meds are not very good. This board would not exist if they were. Most of the treatments are not very good. This board would not exist if they were.
I couldnt agree more that this board wouldnt exist if treatments were "very good".I do think there is room for improvement though.
Posted by SLS on October 4, 2015, at 12:52:02
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 3, 2015, at 23:36:47
> Here's a website I found showing the rate of various types of crimes in the US since 1960
> http://www.disastercenter.com/crime/uscrime.htm
>
> You can compare the numbers to the population numbers shown for each year. And actually, the ratio for violent crimes has decreased a bit in recent years.Is it possible that the statistics are influenced by a differences in reporting practices over the last 55 years?
Interestingly, the rate has been going down steadily since the advent of SSRI antidepressants (1988).
- Scott
Posted by SLS on October 4, 2015, at 14:30:55
In reply to Re: Shooters and Psychiatry, posted by SLS on October 4, 2015, at 12:52:02
> > Here's a website I found showing the rate of various types of crimes in the US since 1960
> > http://www.disastercenter.com/crime/uscrime.htm
> >
> > You can compare the numbers to the population numbers shown for each year. And actually, the ratio for violent crimes has decreased a bit in recent years.
>
> Is it possible that the statistics are influenced by a differences in reporting practices over the last 55 years?
>
> Interestingly, the rate has been going down steadily since the advent of SSRI antidepressants (1988).After reviewing the chart further, I don't understand how anyone would try to use it to make an argument that increased antidepressant use is associated with higher rates of violent crimes.
1. Within a few years of the release of Prozac, violent crimes have gone down steadily.
2. The media attention paid to Prozac and depression beginning in 1988 produced a large increase in antidepressant prescriptions. I believe it is at least 400%.
Wouldn't one expect an increase in the rate of violent crimes by 400% if antidepressants were responsible for producing them? Instead, there is a significant reduction. How can this be?
The statistic I haven't seen yet is the proportion of people that take antidepressants who go on to commit suicide or violent crimes. If you line up 100 people who take antidepressants, how many of them will suffer negative behavioral reactions? What if it is only 3*? The media attention paid to those 3 will be greatly exaggerated and make antidepressants seem like prolific killers. Perhaps negative reactions can be screened for more closely by doctors early in treatment. Weekly or biweekly evaluations might be indicated.
* I have no idea what this number really is. Maybe someone can produce this statistic.
More interesting statistics:
http://www.cdc.gov/nchs/data/databriefs/db76.htm
- Scott
Posted by hello321 on October 4, 2015, at 17:09:49
In reply to Re: Shooters and Psychiatry, posted by SLS on October 4, 2015, at 14:30:55
> > Interestingly, the rate has been going down steadily since the
>
> After reviewing the chart further, I don't understand how anyone would try to use it to make an argument that increased antidepressant use is associated with higher rates of violent crimes.
>
> 1. Within a few years of the release of Prozac, violent crimes have gone down steadily.
>
> 2. The media attention paid to Prozac and depression beginning in 1988 produced a large increase in antidepressant prescriptions. I believe it is at least 400%.
>
> http://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624
>
> Wouldn't one expect an increase in the rate of violent crimes by 400% if antidepressants were responsible for producing them? Instead, there is a significant reduction. How can this be?
>
> The statistic I haven't seen yet is the proportion of people that take antidepressants who go on to commit suicide or violent crimes. If you line up 100 people who take antidepressants, how many of them will suffer negative behavioral reactions? What if it is only 3*? The media attention paid to those 3 will be greatly exaggerated and make antidepressants seem like prolific killers. Perhaps negative reactions can be screened for more closely by doctors early in treatment. Weekly or biweekly evaluations might be indicated.
>
> * I have no idea what this number really is. Maybe someone can produce this statistic.
>
> More interesting statistics:
>
> http://www.cdc.gov/nchs/data/databriefs/db76.htm
>
>
> - Scott
I didn't post those numbers to prove any point. I just posted them for us to look.But the rate of violent crimes continued to increase even after Prozac quickly became a blockbuster soon after it was released. Then a very slight decrease of 0.6 violent crimes came in 1992. Then it further decreased to 746.8 from 757.5 per 100,000 in 1993. In early 1994 the Brady Bill was passed, which mandated federal background checks and a 5 day waiting period for gun purchases, until instant background checks were implemented in 1998. Other nations with stricter gun control laws have much lower homicide rates than the United States. Even with antidepressant use being lower or much lower in these nations compared to the USA.
Http://www.businessinsider.com/canada-australia-japan-britain-gun-control-2013-1
Posted by Phillipa on October 4, 2015, at 17:31:20
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 4, 2015, at 17:09:49
No meds for psychopaths & if they want a gun they will steal one or buy one illegally off the street. P
Posted by Phillipa on October 4, 2015, at 17:51:42
In reply to Re: Shooters and Psychiatry, posted by Phillipa on October 4, 2015, at 17:31:20
Posted by baseball55 on October 4, 2015, at 19:33:24
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 4, 2015, at 17:09:49
And where exactly is the evidence that mass shooters take anti-depressants? Can you name one? I don't think crime stats have anything to do with depression or anti-depressants, since depressed people or people recovering from depression rarely commit crimes in the first place.
Changes in the crime rate since the 1960s are probably due to:
*greater access and availability of guns (see the book Fist, Stick, Knife, Gun) which lead to more disputes escalating to murder.
*The crack epidemic that caused huge spikes in violent crime in the 80s.
*Some people argue that greater availability of birth control and abortion reduced the birth of unwanted children among single parents and caused crime rates to decline by the 90s, when those children would have reached prime crime-involvement years.
*Aging of the population. Crime rates decline with age. Prime crime ages are 16-25.
*More intense focus on street level policing and incarceration in the mid-80s.
* Better reporting. For example, rape, in the 60s and 70s, was rarely reported or prosecuted. In the late 70s and early 80s, a lot of crime in high crime rate cities went unreported because the police just didn't bother investigating anything but murders.
*reduction in gang activityI don't know of one serious study of crime rates by criminologists or sociologists of crime that mentions antidepressants as either a cause or solution of violent crime.
Psych drugs are not responsible for everything, nor is mental illness.
Posted by hello321 on October 4, 2015, at 21:05:01
In reply to Re: Shooters and Psychiatry, posted by baseball55 on October 4, 2015, at 19:33:24
> And where exactly is the evidence that mass shooters take anti-depressants? Can you name one? It might make this convo more productive if you followed what is said during it.
>I don't think crime stats have anything to do with depression or anti-depressants, since depressed people or people recovering from depression rarely commit crimes in the first place.
Why do you think this? Any evidence?
> Changes in the crime rate since the 1960s are probably due to:
>
> *greater access and availability of guns (see the book Fist, Stick, Knife, Gun) which lead to more disputes escalating to murder.
> *The crack epidemic that caused huge spikes in violent crime in the 80s.
> *Some people argue that greater availability of birth control and abortion reduced the birth of unwanted children among single parents and caused crime rates to decline by the 90s, when those children would have reached prime crime-involvement years.
> *Aging of the population. Crime rates decline with age. Prime crime ages are 16-25.
> *More intense focus on street level policing and incarceration in the mid-80s.
> * Better reporting. For example, rape, in the 60s and 70s, was rarely reported or prosecuted. In the late 70s and early 80s, a lot of crime in high crime rate cities went unreported because the police just didn't bother investigating anything but murders.
> *reduction in gang activityTrue, these things you listed probably have had an effect on the crime rate.
> I don't know of one serious study of crime rates by criminologists or sociologists of crime that mentions antidepressants as either a cause or solution of violent crime.
Do you think serious studies need to be done then?
> Psych drugs are not responsible for everything, nor is mental illness.
No one said this
Posted by SLS on October 4, 2015, at 21:16:43
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 4, 2015, at 17:09:49
>
> > > Interestingly, the rate has been going down steadily since the
> >
> > After reviewing the chart further, I don't understand how anyone would try to use it to make an argument that increased antidepressant use is associated with higher rates of violent crimes.
> >
> > 1. Within a few years of the release of Prozac, violent crimes have gone down steadily.
> >
> > 2. The media attention paid to Prozac and depression beginning in 1988 produced a large increase in antidepressant prescriptions. I believe it is at least 400%.
> >
> > http://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624
> >
> > Wouldn't one expect an increase in the rate of violent crimes by 400% if antidepressants were responsible for producing them? Instead, there is a significant reduction. How can this be?
> >
> > The statistic I haven't seen yet is the proportion of people that take antidepressants who go on to commit suicide or violent crimes. If you line up 100 people who take antidepressants, how many of them will suffer negative behavioral reactions? What if it is only 3*? The media attention paid to those 3 will be greatly exaggerated and make antidepressants seem like prolific killers. Perhaps negative reactions can be screened for more closely by doctors early in treatment. Weekly or biweekly evaluations might be indicated.
> >
> > * I have no idea what this number really is. Maybe someone can produce this statistic.
> >
> > More interesting statistics:
> >
> > http://www.cdc.gov/nchs/data/databriefs/db76.htm
> >
> >
> > - Scott
> I didn't post those numbers to prove any point. I just posted them for us to look.
>
> But the rate of violent crimes continued to increase even after Prozac quickly became a blockbuster soon after it was released.Prozac was released in December of 1988. However, it didn't become a blockbuster until the media made it into one. It didn't make the cover of Newsweek magazine until March 26, 1990. I don't think it reasonable that Prozac should increase prescription numbers by 400% in the two years following the magazine article. Violent crimes began to fall beginning in 1993 according the chart you posted. Maybe Prozac reduced violent crime. Fewer depressed and anxious people = reduced violent crime? It would make a wonderful explanation for what we see in the statistics you cited. But, then again, maybe not.
So now you have me confused. I forgot exactly what we were talking about.
- Scott
Posted by hello321 on October 4, 2015, at 22:03:37
In reply to Re: Shooters and Psychiatry, posted by SLS on October 4, 2015, at 21:16:43
> >
> > > > Interestingly, the rate has been going down steadily since the
> > >
> > > After reviewing the chart further, I don't understand how anyone would try to use it to make an argument that increased antidepressant use is associated with higher rates of violent crimes.
> > >
> > > 1. Within a few years of the release of Prozac, violent crimes have gone down steadily.
> > >
> > > 2. The media attention paid to Prozac and depression beginning in 1988 produced a large increase in antidepressant prescriptions. I believe it is at least 400%.
> > >
> > > http://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624
> > >
> > > Wouldn't one expect an increase in the rate of violent crimes by 400% if antidepressants were responsible for producing them? Instead, there is a significant reduction. How can this be?
> > >
> > > The statistic I haven't seen yet is the proportion of people that take antidepressants who go on to commit suicide or violent crimes. If you line up 100 people who take antidepressants, how many of them will suffer negative behavioral reactions? What if it is only 3*? The media attention paid to those 3 will be greatly exaggerated and make antidepressants seem like prolific killers. Perhaps negative reactions can be screened for more closely by doctors early in treatment. Weekly or biweekly evaluations might be indicated.
> > >
> >
> Prozac was released in December of 1988. However, it didn't become a blockbuster until the media made it into one. It didn't make the cover of Newsweek magazine until March 26, 1990. I don't think it reasonable that Prozac should increase prescription numbers by 400% in the two years following the magazine article. Violent crimes began to fall beginning in 1993 according the chart you posted. Maybe Prozac reduced violent crime. Fewer depressed and anxious people = reduced violent crime? It would make a wonderful explanation for what we see in the statistics you cited. But, then again, maybe not.
>
> So now you have me confused. I forgot exactly what we were talking about.
>
>
Lol I've gotten a bit confused about it too. I suppose the thread started out about what was causing all these mass shootings we hear about lately. And I posted one reason for it may actually be psychiatric meds.
Maybe prozac and other psych meds have worked to make some who take it less prone to violence. I think this is likely. But I also believe these meds can do the opposite.Also, here is a study done is Sweden that concluded depressed people undergoing outpatient psychiatric treatment are more likely to commit violent crimes. Well it didn't come to this conclusion exactly. Just that depressed people are more likely to commit violent crimes. Though all the folks in the study were diagnosed nd being treated for depression by psychiatric services.
"The study only included patients diagnosed and treated for depression by outpatient psychiatric services. People who required inpatient admissions and those treated by their GPs were excluded, so it may not be representative of people with different severities of depression."
Posted by PeterMartin on October 5, 2015, at 9:33:41
In reply to Re: Shooters and Psychiatry, posted by hello321 on October 4, 2015, at 22:03:37
John Oliver nailed it:
John Oliver slams GOP candidates for citing mental health in response to Oregon mass shooting:
https://www.youtube.com/watch?v=NGY6DqB1HX8
Posted by Tomatheus on October 5, 2015, at 12:40:28
In reply to Shooters and Psychiatry, posted by bleauberry on October 3, 2015, at 7:11:44
Psych Central's John Grohol, Psy.D., argued in a blog entry published today that scientific data do not support the idea that people with mental illness are an "important piece of the puzzle of violence in America."
Dr. Grohol wrote: "We need to stop pointing fingers and scapegoating the percentage of the population with mental illness. That kind of behavior is pure discrimination and bigotry. I expect policymakers and Congress people to respect all of their fellow citizens, including those with a mental illness - not call them out for special, discriminatory treatment."
Read the full blog entry below:
http://psychcentral.com/blog/archives/2015/10/05/congress-policymakers-stop-scapegoating-mental-illness-in-mass-shootings/Tomatheus
Posted by hello321 on October 5, 2015, at 14:56:12
In reply to Re: Shooters and Psychiatry, posted by Tomatheus on October 5, 2015, at 12:40:28
Some have a problem with pointing a finger at the chemicals used to treat mental illnesses as one factor behind violent crimes. Others are outraged by mentally folks being singled out. While others disapprove of the inanimate objects used to commit the crimes being blamed. I guess you can't make everyone happy.
Then others demand only knowledge gained from well designed studies be used to decide what action should be taken. While others are upset and claim discrimination if these numbers single out a certain group.
I suppose we can only expect progress to be very slow and meet many roadblocks along the way, if progress is ever even achieved.
It is true that fewer violent crimes are being committed by folks diagnosed and treated for depression. And that's great. But that's like pointing out that fewer crimes are being committed by African Americans in a city consisting of 80% Caucasians, if a higher percentage of African Americans have committed violent crimes in this city. Of course it is no good to judge anyone before you know them. And if a non-violent person is being singled out by anyone as a factor in the crime rate, that helps no one.
As I've said, my thoughts are that the brain altering prescriptions being prescribed to depressed people are, in some cases, causing or worsening their negative thought processes and making them more likely to become violent. The study I posted in my last post showed that a modest but still significantly higher percentage of people diagnosed and being treated for depression by a psychiatrist have been convicted of violent crimes. It talked about some shortcomings in the study that should be addressed by future studies. Though one good thing about the study was that it compared the time before the people studied sought psychiatric treatment (the unmedicated version of themselves) to the time when they were being treated with psychiatric medications. It appears to be a well done study that came up with numbers that could be helpful when deciding what steps should be taken to decrease the amount of violence occurring.
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