Posted by yxibow on July 9, 2005, at 15:16:32
In reply to Re: Tardive Dyskinesia from Zyprexa... AGAIN!, posted by med_empowered on July 9, 2005, at 5:48:03
> hey! I don't know your situation exactly, but I >would like to offer some advice: if you think you >may have true TD (not simply EPS), you may want >to ask a DIFFERENT doctor to diagnose the >condition. Some of the most expensive lawsuits >psychiatrists have faced have dealt with TD.
..management of antipsychotic medications and their usefulness is a difficult balance, but at the end of the day, sans complete psychosis, it is informed consent to take them despite their potential consequences. It's an unfortunate balance, one that I or anyone who takes them has to take into account :/
> I'm not saying "sue your doctor," but I am >saying that psychiatrists have a really, really >BAD history of diagnosing TD, especially when >dealing with their own patients and financial >liability.
Actually I would believe that a psychiatrist should have a good, if not overprotective sense of diagnosing TD considering the high costs of malpractice insurance. But diagnosing TD is subjective, yet at times crude and simple -- most often done with the AIMS (Abnormal Involuntary Movement Scale). A doctor who doesn't perform this at some reasonable interval whether interactively or observationally is not looking for TD enough.
>If you do in fact have TD, the doctor who makes >the diagnosis should be able to do what he/she >can for treatment and/or refer you to others for >help.
There is nothing wrong with a second opinion (I've been there too).
>(still, psychiatrists tend to miss even flagrant >TD all too often; sometimes, you're better off >going to a neurologist, or even a GP).
This I would say is a subjective opinion, I can't refute or not.
>If you do have TD, you could try >Clozaril...however, even Clozaril has had some >EPS/TD associated with it, along with NMS, heavy >sedation, drooling, and weight gain.
This I almost completely agree with... Clozaril has its place but with socially unpleasant side effects, almost zero TD, but most seriously a 2% chance of agranulocytosis (low white blood count).
>Personally, my advice would be to find a doc >willing to treat whatever it is you are dealing >with WITHOUT neuroleptics. The only sure-fire way >to avoid TD/EPS is to avoid antipsychotics >entirely.
It's hard to treat a florid psychotic disorder without neuroleptics unfortunately, with the possible exception of Amoxapine which is a neuroleptic in disguise. But I do not know the patients full dx.
>The big difference between all the atypicals, >including clozaril, and the old antipsychotics >seems to be the frequency and severity of side >effects such as EPS and TD...
As so far shown, definately so, especially with the newest of the atypicals.
poster:yxibow
thread:524781
URL: http://www.dr-bob.org/babble/20050708/msgs/525493.html