Posted by Cam W. on April 3, 2000, at 22:40:52
In reply to Question for Cam W., posted by saint james on April 3, 2000, at 18:27:12
James - There are days when I think atypicals should be in the drinking water. I don't think that the newer atypicals would do anymore harm to someone with psychosis, than without psychosis. (This probably goes for the traditional neuroleptics as well, but with the movement disorder problems, I would want to make damn sure they were going to help in a non-psychotic condition.). I am old enough to remember when massive doses of chlorpromazine were given just to shut someone up. You don't see that being done much anymore, though.I agree with you to try other meds first (with adequate trials), but sometimes you have to use everything in your arsenal, hoping that one will work. If you have run the gamut of traditional therapies, then try an antipsychotic. (or paraphrasing an old commercial, "You know, Zyprexa isn't just for psychosis, anymore!")
On your comment about zeroing in on the area causing psychosis, Nancy Andreasen has some very interesting articles on the role of the thalamus in schizophrenia. The lack of dopaminergic synaptic pruning between the thalamus and prefrontal cortex (as well as other areas in the loop) is an interesting concept, that can actually be seen in brain slices. I don't think we will ever be able to cure schizophrenia, but we should better be able to alleviate a lot of the suffering. Dr.Andreasen is the editor of the American Journal of Psychiatry (I believe). It is a shame that she does not still take a more active role in the research. I guess someone has to sit at the top and see the big picture.
Dr.M.Tsang from Harvard did an interesting study a few years ago. He gave small doses of Risperdal (< 0.5mg) to non-psychotic first degree family members of people with schizophrenia. Their cognition and other abilities improved. I find this facinating.
Sorry for the digression. I think that you use antipsychotics when deemed necesssary. This is done after understanding their actions on the body and having an educated guess at what you are trying to treat. We sometimes take a reductionist view of our medications (eg. this drug raises serotonin; this drug lowers dopamine). We really can't do this in a plastic, dynamic system. All systems need to be accounted for in treatment regimen. Hopefully more doctors are taking this into account when treating patients. - Cam W.
poster:Cam W.
thread:28773
URL: http://www.dr-bob.org/babble/20000401/msgs/28797.html