Posted by yxibow on July 10, 2005, at 2:14:34
In reply to Re: Tardive Dyskinesia from Zyprexa... AGAIN!, posted by med_empowered on July 9, 2005, at 20:56:03
> Serentil and Thorazine hit the US market in >1954, the first mentions of the TD syndrome were >in the international literature by the end of the >1950s, and by the 1960s the "Thorazine Shuffle" >was being noticed by anyone involved with those >receiving neuroleptics.
I do not deny this -- we didn't know -- the first neuroleptic actually was reserpine, by accident, I believe. Its an unfortunate fact that the most powerful medications we have for individuals with serious psychotic disorders come with the price of potential TD, especially the earliest medications.
This is what I meant by informed consent, or as informed as one can be, given the conundrum that an individual in serious danger of harming themselves or others may not technically fit an "informed consent" state until stabilised.
Its a catch 22 for all antipsychotics, and is still a state where we are in the development of such drugs -- 'the operation was successful but the patient died'
> In 1968, the FDA finally required that >neuroleptics come with a TD-risk warning. However, it wasn't until 1980 that the APA organized the TD task force to actually study the phenomenom. With the introduction of atypicals, shrinks have, by and large, once again taken the "TD: dont ask, dont tell" policy as their professional MO.This, while I don't want to get into an argumentative state I do believe is absolute rubbish. There is every indication in todays practice, especially with the introduction of atypicals, that the least dosage required is followed. Still some individuals may benefit only from higher dosages which may put them at risk of TD. It is a lumping together of all psychiatrists to say that there is some nefarious plan or callous disregard of their patients. There are indeed bad psychiatrists. But if one is to look closer at those who have entered the field, be it psychiatry or psychology, one may very well discover that they went into it for very personal reasons -- family members, friends, those who affected them enough with the suffering of biochemical disorders that they felt a calling.
I don't suffer from a psychotic disorder but a complex anxiety driven one which would take quite a while to explain -- again, with informed consent I take Seroquel because it betters my life, one that was ripped away from me several years ago. But I know, that even with peer reviewed studies such as a British one that one could extrapolate the likelyhood of TD with quietapine is on the order of 1/4% per year give or take. Do I risk TD or do I want to manage my life the best I can? Its a hard one to take, one that scares many away from promising treatment, though even TD can be reversible in at least 30% of the time and made no worse in another 30%.
> As for neuroleptic-free treatment of psychotic >disorders...everyone, I'm sure, has heard of >Mosher's Soteria House.I cannot comment on alternative practices in the realm of psychiatric drug discussion. There may be visionaries who try psychotherapeutic methods, and for some it may succeed. For some who suffer from schizophreniform disorders, an "awakening" in later life sometimes occurs where medication treatment is no longer necessary. This is probable in the case of John Nash ('Beautiful Mind').
>Finally, I find your critique of Clozaril--as >highly effective but having "socially >undersirable consequences"--to reflect an utter >lack of empathy for those who have psychotic >disorders.Rather I was trying to use the most neutral and succinct vocabulary I could possibly use to follow the ethos of this forum. Socially undesirable -- I meant in the most painful sense for the sufferer of a psychotic disorder. I could have gone on to describe the littany of effects that Clozaril can have on an individual but I chose to summarise it in that way. If it was found to be offensive, it was meant in an entirely different fashion I assure you, just as the effects of TD can make a sufferer feel shunned from society, the side effects of medication, such as in the treatment of cancer, can also do so. I believe the statement was taken too literally but I retract how it was phrased.
>Yes, the psychosis is controlled, but >spontaneity, humor, introspection, wit, and >personality also find themselves effectively >"controlled" during treatment with Clozaril and >many other neuroleptics.This is known as "blunting" and is common among virtually all neuroleptics, and which I suffer to a degree from Seroquel as well. So I can and certainly do sympathise with this. The "there" isnt quite "there". And even to a lesser degree this can occur with SSRIs.
But are we to deny patients in desperate need of some collectivity of their daily lives, or are we to admit, yes, we've come a long way since 1950, but we have many years to go. And in the here and now, we use what we can. I only wish we had more.
poster:yxibow
thread:524781
URL: http://www.dr-bob.org/babble/20050708/msgs/525646.html