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Dr. Bob is Robert Hsiung, MD,
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Posted by med_empowered on January 6, 2007, at 18:25:42
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:13:06
I seem to recall seeing studies from as early as the laste 50s and early 60s (back when "antipsychotics" were being called "ataractic" drugs") that showed, even then, that the drugs weren't helpful.
I'm not anti-drug per se, but I do think we have to be careful about the drugs we go around spraying people with. Antipsychotics have a pretty long history of causing bad side effects. I can see how giving someone who is psychotic a neuroleptic, especially if you conceive of acute schizophrenic psychosis as a psychosis-heavy form of Bipolar Mania, as some have suggested. Do it short term, minimize discomfort, stop the episode, prevent too much long term damage from their actions. But months and years of this stuff? It seems ill advised. Very, very ill advised.
If someone must be medicated in schizophrenia (and a lot of people seem to do fine, over time, w/o meds), there are other meds. Try the anticonvulsants. Use benzos. Maybe even give good 'ole placebo a whirl. Opiates may be effective. But neuroleptics? To say that the "only" drugs effective for schizophrenia have "unfortunate side effects" is inaccurate. There are other meds to use--they may not be specifically "antipsychotic," but there are indications that they work on some symptoms in a good number of patients. I think the problem isn't trying to medicate some of the symptoms of schizophrenia, at least for a while--that can actually give patients and families a needed break from active psychosis--I think the problem is that the meds being used (D2 blockers) tend to be unpleasant and carry unpleasant and unwanted side effects.
Posted by linkadge on January 6, 2007, at 18:26:04
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by SLS on January 6, 2007, at 18:00:43
>Yes. The schizophrenic episode itself is >neurotoxic.
I would suggest that the drugs are more neurotoxic.
People have used the argument that depression is more toxic than antidepressants, but data suggests that no such protective effect on antidepressants exist. (tianeptine is an exception.)
We know from animal studies that the drugs are neurotoxic, we also know that AP's do not fix or halt the underlying disorder. So you are taking a damaging drug that does not necessarily halt the underlying disease progression.
The data on conventionals is fairly conclusive to indiacate brain dammage. I don't think the typicals have been around long enough to suggest that they halt the disease.
Linkadge
Posted by linkadge on January 6, 2007, at 18:29:11
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by med_empowered on January 6, 2007, at 18:25:42
I think you'd see a better long term outcome with vitamin C, and Niacin.
Linkadge
Posted by fca on January 6, 2007, at 18:39:15
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:13:06
spend more time on this--I have lived with this for so long perhaps I am blind to the other side. I really do not want to spend more time researching it or debating it. I am confident that science and the lives of 100s of thousands are on my side. I know this is an unfair tactic but I need to move on. Like you, I am not sure whether the newer atypicals are better for many but I know for a fact that almost 1/3 of persons with schizophrenia who never responded to any treatment now have a realistic chance of improving. If you wish, start researching the PET studies done before and after serious periods of decompensation. Or better yet go back and look at the mortality and morbidity statistics for people with schizophrenia who were alive 50-70 years ago before any of the major antipsychotics. I would guess that most were dead by their mid fifties and/or had such overwhelming cognitive limitations that they were essentially unable to function. People with schizophrenia still have a much shorter life span than others but I bet it sure is longer than before. Sorry for aborting the debate because it is worth having. Taking the dog for a short run and then popcorn and a DVD. fca
Posted by Phillipa on January 6, 2007, at 18:57:52
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 11:08:45
How do you recover from schizophrenia without some sort of med? And maybe the payment would allow some of them to not have to live in a shelter. And doesn't true schizophrenia show up on MRI's? Love Phillipa
Posted by Phillipa on January 6, 2007, at 19:09:01
In reply to the case for neuroleptics is kind of weak, posted by med_empowered on January 6, 2007, at 11:50:21
Med seriously when clozapine first came out I saw miracles in patients that did not respond well to other neuroleptics or had things like bladder reactions. And with cogentin etc. many side effects of the older antipsychotics were completed avoided. I belive it was before a med like akentin or cogentin was available that most of the TD or dystonia resulted. My opinion based on what I saw. But I did see nonfunctional people go out and get jobs, get married. And had a very good quality of life. Love Phillipa
Posted by ed_uk on January 6, 2007, at 19:18:59
In reply to Re: Patient paid to accept neuroleptic depot injec » ed_uk, posted by SLS on January 6, 2007, at 17:51:40
Hi Scott
>Is it your guess that this is the result of the illness or of a neuroleptic-facilitated cognitive deficit?
I think it is the result of his illness.
>Is this the fault of the drug or the doctor?
The doctor.
What concerns me is that drugs with a high incidence of side effects (eg. depots) are being given to patients who may not be capable of reporting or expressing their side effects to the prescriber. In some cases, continued administration of medication results despite serious side effects.
>In fact, I would appreciate it if you would pay for my next refill of Abilify.
I'm sure :) They certainly make a huge profit on the atypicals.
Ed
Posted by Phillipa on January 6, 2007, at 19:21:14
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by laima on January 6, 2007, at 15:28:24
Except if truly psychotic money is not something they are even aware of they just want the symptoms of voices tv talking to them, spiritual warfare in the minds to go away. A lot go off their meds to sell them for money. And it takes quite a while for the symptoms to abate as they tend to make the patient extremely tired. Also very poor hygiene creates other problems as well. Love Phillipa
Posted by linkadge on January 6, 2007, at 20:59:15
In reply to Linkadge. to late in the evening to, posted by fca on January 6, 2007, at 18:39:15
>I know this is an unfair tactic but I need to >move on.
No worries.
>but I know for a fact that almost 1/3 of persons >with schizophrenia who never responded to any >treatment now have a realistic chance of >improving.I am not saying that antipsychotics may not produce some impressive short term changes in behavior in schizophrenics, but that is far from proof of helping them long term.
>If you wish, start researching the PET studies >done before and after serious periods of >decompensation.
We could also look at post mortem neuroleptic induced morphological alterations in brain structure.
>Or better yet go back and look
>at the mortality and morbidity statistics for >people with schizophrenia who were alive 50-70 >years ago before any of the major antipsychotics.I was under the impression that antipsychotics increased morbidity. If you are referring to suicide risk, clozapine is the only antipsychotic with any proven effect on suicide rate.
>I would guess that most were dead by their mid >fifties and/or had such overwhelming cognitive >limitations that they were essentially unable to >function.There are many studies that show that *long term* neuroleptic use worsens cogntative function in schizophrenia.
Time Dependent Cognitive Deficits Associated with First and Second Generation Antipsychotics: Cholinergic Dysregulation as a Potential Mechanism
http://jpet.aspetjournals.org/cgi/content/abstract/jpet.106.106047v2
Evidence of neuroleptic induced brain dammage:
http://www.namiscc.org/Research/2003/NeurolepticInducedBrainDamage.htm
Dramatic downregulation of BDNF following Haldol treatment.
The Effect of Antipsychotics on Cognition in Schizophrenia
http://www.cnsforum.com/magazine/focus/cognition_schizophrenia/
"Neuroleptics were associated with the reduction of psychotic symptoms of schizophrenia, but they did not demonstrate any significant impact on cognitive features of the disease (Sweeney et al., 1991)."
"Conventional antipsychotics, which primarily block D2 dopamine receptors, may demonstrate no effect (Berman et al., 1986) or minimal beneficial effect on cognitive functioning (Serper et al., 1994) or can even further impair cognitive functioning (Sweeney et al., 1991). Also, traditional antipsychotics cause extrapyramidal symptoms (EPS), which significantly decrease speed on cognitive tasks involving motor output and readiness to respond."
"Acute treatment with typical neuroleptics can result in a deterioration in some aspects of attention and motor behavior"
"neuroleptic drugs lack the ability to improve the various domains of cognitive function impaired in schizophrenia."
>People with schizophrenia still have a much
>shorter life span than others but I bet it sure
>is longer than before."However, it is possible that the impact of adverse effects on the cardiovascular system related to certain antipsychotic drug use may well increase the prevalence of mortality and morbidity due to cardiovascular events and may also play a significant role in the reduced life expectancy of the patient with schizophrenia"
Linkadge
Posted by linkadge on January 6, 2007, at 21:02:44
In reply to Re: the case for neuroleptics is kind of weak » med_empowered, posted by Phillipa on January 6, 2007, at 19:09:01
>And with cogentin etc. many side effects of the >older antipsychotics were completed avoided
Cogentin simply blocks the symptomatic expression of TD. There is no evidence that it blocks the morphocological changes that resulting from AP's that cause dyskinesias to progress.
Its just like how they can help parkinsons, but they do nothing to slow the progression of parkinsons.
Linkadge
Posted by linkadge on January 6, 2007, at 21:14:01
In reply to Re: the case for neuroleptics is kind of weak, posted by linkadge on January 6, 2007, at 21:02:44
You are saying that you've AP's must be good because you've seen so many patients improve on them.
Well, lets think back to the early days of L-dopa usage. A Parkinson's patient was brought out on stage, shaking, perhaps in a wheelchair. He was then taken backstage and administered l-dopa. The patient then walks back in, dances around, plays the piano etc.
To the untrained observer, l-dopa was the cure.
It wasn't till later that researchers realized that l-dopa was actually speeding the progression of the illness, and enhancing dopaminergic cell loss in movement areas of the brain.
So, I would argue that it is necessary to look very long term, to see if these drugs are really benifitting the patients.
Whats the point of winning a battle if you loose the war?
Linkadge
Posted by laima on January 6, 2007, at 22:22:01
In reply to Re: Patient paid to accept neuroleptic depot injec » linkadge, posted by Phillipa on January 6, 2007, at 18:57:52
Fish oil? Vitamins? Stress relief, social support? Therapy? Quit illegal drugs? Excercise and good diet?Not even clear anymore if there is a such thing as "true schizophrenia" per the most up to date reports--they argue it's more of an umbrella term.
> How do you recover from schizophrenia without some sort of med? And maybe the payment would allow some of them to not have to live in a shelter. And doesn't true schizophrenia show up on MRI's? Love Phillipa
Posted by laima on January 6, 2007, at 22:23:38
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Phillipa on January 6, 2007, at 19:21:14
They go sell their antipsychotic drugs somewhere? Who on earth buys that stuff?> Except if truly psychotic money is not something they are even aware of they just want the symptoms of voices tv talking to them, spiritual warfare in the minds to go away. A lot go off their meds to sell them for money. And it takes quite a while for the symptoms to abate as they tend to make the patient extremely tired. Also very poor hygiene creates other problems as well. Love Phillipa
Posted by Phillipa on January 6, 2007, at 22:27:25
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by laima on January 6, 2007, at 22:22:01
Laima problem as I would see it with fish oil etc is that they would be paranoid to take them. Maybe first take it in steps. Eleviate the paronoia and say when it's gones off the antipschotics and lets try vitamins? I have a schizophrenic person I e-mail with who love haldol, lithium and anafranil I'll ask him what he thinks about your idea okay? Love Phillipa
Posted by Phillipa on January 6, 2007, at 22:30:10
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by laima on January 6, 2007, at 22:23:38
Someone posted that people in jail were snorting seroquel horrible. But that's evidently going on too. Love Phillipa
Posted by Quintal on January 6, 2007, at 22:38:32
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by laima on January 6, 2007, at 15:19:33
>And I keep mulling over my experience with the prima-donna psychiatrist who genuinely believed that if I felt zyprexa was making me feel bizarre, it was evidence of a developing psychosis and indicated that I needed even MORE. Meanwhile, I noticed she had a zyprexa pen and notepad.
I had that exact experience with a cocky new psychiatry graduate who tried to tell me Zyprexa was a regular antidepressant like Prozac. When I corrected him he asked me how I knew that olanzapine was the generic name despite the fact that it was written in plain view on his desk top jotter and coffee mug. I did eventually take it and he refused to believe that 5mg was making me feel spaced out and drowsy. He also thought Zyprexa would cause no significant impairment in driving performance even if taken in the morning.
I'm believing ever more strongly that they should really think about taking some of these drugs themselves before making comments like that.
Q
Posted by yxibow on January 6, 2007, at 22:38:40
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by linkadge on January 6, 2007, at 18:29:11
> I think you'd see a better long term outcome with vitamin C, and Niacin.
>
> LinkadgeMy experience with time release Niacin has been less than stellar -- the idea of low flush did not work, it did not solve any anxiety, in fact it generated more and flushing. But as they say, your miles may vary.
Posted by laima on January 6, 2007, at 22:39:59
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Phillipa on January 6, 2007, at 22:27:25
?
I don't know much about the treatment of schizophrenic disorders, but heard that fish oil is effective for many- much as it's effective for many for depression. Brain is made out of fat...
I still think therapy/stress reduction/coaching shouldn't be ignored, and there is a lot of literature which posits that marijuana or other drugs can bring out schizophrenia in individuals who already are at risk. (Not to restart that debate--it's a speculation that a lot of experts are bringing up- thats all.)
I'll have to reread the article- are these people who are being coerced into shots getting any therapy or other social support???Again, "schizophrenia" seems to be increasingly thought of as an umbrella term- not just one disorder. Bunch of various disorders, various symptoms, causes, and prognosises.
Thank god I wasn't worse off when that awful doctor suggested that my dislike of zyprexa was evidence of psychosis! Glad no one forces any of us to get anti-depressant shots. One can argue about how expensive depression is for society, too: unemployment, presenteeism, drug abuse, health-care costs...sounds terrible.
Organ sellers often can use the money, too-and they do such a nice favor for the buyers.
> Laima problem as I would see it with fish oil etc is that they would be paranoid to take them. Maybe first take it in steps. Eleviate the paronoia and say when it's gones off the antipschotics and lets try vitamins? I have a schizophrenic person I e-mail with who love haldol, lithium and anafranil I'll ask him what he thinks about your idea okay? Love Phillipa
Posted by laima on January 6, 2007, at 22:47:49
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 22:38:32
Wow! How about that Lilly sales job?Imagine you, mental patient, knowing zyprexa's generic name. Bet you startled the young doctor :)
I agree! I too have occasionally thought that some of these doctors got some nerve telling us how we feel using certain drugs when all they are going by is observation, literature, and sales reps.
I've had experiences like this numerous times:
"Heart palpitations? No, you don't have heart palpitations- it's not one of the side effects on the list." (Note in chart: patient thinks she has heart palpitations.) Etc.> I had that exact experience with a cocky new psychiatry graduate who tried to tell me Zyprexa was a regular antidepressant like Prozac. When I corrected him he asked me how I knew that olanzapine was the generic name despite the fact that it was written in plain view on his desk top jotter and coffee mug. I did eventually take it and he refused to believe that 5mg was making me feel spaced out and drowsy. He also thought Zyprexa would cause no significant impairment in driving performance even if taken in the morning.
>
> I'm believing ever more strongly that they should really think about taking some of these drugs themselves before making comments like that.
>
> Q
Posted by laima on January 6, 2007, at 22:48:55
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Phillipa on January 6, 2007, at 22:30:10
Wow- that sounds awfully bizarre! I wonder if they were bored and trying to fall asleep?> Someone posted that people in jail were snorting seroquel horrible. But that's evidently going on too. Love Phillipa
Posted by yxibow on January 6, 2007, at 22:50:34
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 22:38:32
> >And I keep mulling over my experience with the prima-donna psychiatrist who genuinely believed that if I felt zyprexa was making me feel bizarre, it was evidence of a developing psychosis and indicated that I needed even MORE. Meanwhile, I noticed she had a zyprexa pen and notepad.
>
> I had that exact experience with a cocky new psychiatry graduate who tried to tell me Zyprexa was a regular antidepressant like Prozac. When I corrected him he asked me how I knew that olanzapine was the generic name despite the fact that it was written in plain view on his desk top jotter and coffee mug. I did eventually take it and he refused to believe that 5mg was making me feel spaced out and drowsy. He also thought Zyprexa would cause no significant impairment in driving performance even if taken in the morning.
>
> I'm believing ever more strongly that they should really think about taking some of these drugs themselves before making comments like that.
>
> QYou will always find "green" (new) psychiatrists lulled by current medical practices but having no patient-hour experience themselves. The questions to ask are how much peer experience does your psychiatrist have? Do they have regular discussions and anonymous journal club meetings with other psychiatrists more experienced than themselves.
There is something to be said for conservatism in psychiatry even if it means that the Lyrica you ask for may not be given quite as soon as you would like because they don't have the patient-hours with that drug.
Example, myself -- I have to take on occasion atropine like agents such as Artane for sialorrhea due to complex adjustments in medication. I insisted that it didn't take effect until a higher dose and my doctor relented and gave me a larger prescription. Bottom line with all my medications I had chill spells. (slight to medium atropine toxicity -- mostly uncomfortableness) Mea culpa, and less was better. Nothing fatal, but my doctor who practices on the fairly conservative side since I will always have some side effect to a new drug, we agreed perhaps it was a bit too much.
But some doctors who aren't as experienced, just pull out the script pad once a month. Blame it on HMO style care.
-- tidings
Posted by yxibow on January 6, 2007, at 23:03:14
In reply to Re: Patient paid to accept neuroleptic depot injection » med_empowered, posted by Phillipa on January 5, 2007, at 22:34:53
> Med I have to disagree as I saw so many schizophenics off their meds and miserable with voices and seeing things, and once stabalized they were productive in society again and happy and felt normal. Love Phillipa not by force
I too have to disagree. I happen to live near a certain fairly liberal city on the west coast of the US which has become a magnet for homeless feeding, homeless congregation in general. A fair portion of those there are not on medication, are probably seeing things and hearing voices, may be agressive -- because the state dumped its mental health population on the streets in the 60s due to lack of funding. Its a battle thats becoming more conservative as businesses and people don't want "those people" on their stoop, and mass feedings attracting large crowds.
Given a depot injection, and maybe even being paid for it, better yet paid for it in food and some sort of temporary housing not on the bluff parks where they sit daily talking to the air, making a stink and defecating and other lovely things, but somewhere else in the city, instead of using the money to become intoxicated, some people might be well enough to return to some civic oriented job.
Its not a lovely thought for things to be done by force, so an incentive depot injection is better than by force but sometimes voices and intoxication lead to violence. Schizophrenia is a greater than $2 billion problem annually in the US. And by problem I mean the sheer misery that people must endure -- I mean no ill will to anyone on here with a schizophreniform disorder.
The trouble is, once it becomes unruly, eventually they end up in a police cruiser and taken and probably evaluated, given a depot injection and discharged with medication that is never taken and the cycle continues. Its disheartening but that's our system.
-- tidings
Posted by yxibow on January 6, 2007, at 23:08:42
In reply to Patient paid to accept neuroleptic depot injection, posted by ed_uk on January 5, 2007, at 18:47:06
> From PJOnline.........
>
> Financial incentives may improve patients’ adherence to their antipsychotic medication
>
> Financial incentives to encourage patients to adhere to antipsychotic medication might help them stay out of hospital, according to UK researchers (Psychiatric Bulletin 2007;31:4). However, their conclusions are reached from limited data.
>
> The researchers, based in East London, explored the use of direct financial incentives through questionnaires sent to 150 assertive outreach teams in England and by offering payments of £5–£15 to five formerly non-adherent patients for single depot injections of their antipsychotic medication.
>
> The researchers surmised from the 70 questionnaire responses returned that attitudes towards the approach are generally negative. Most outreach team managers (76 per cent) had objections to such schemes and just under half (42 per cent) considered the approach unethical.
>
> However, the researchers say that patients who accepted the offer of payment (four of the five patients in the study) had improved adherence to their medication and three of the patients have not been admitted to hospital since entering the scheme.
>
> The researchers concede that there are a number of practical issues that need to be addressed if this scheme is to become widespread. They conclude: “Financial incentives might be a treatment option for a high-risk group of non-adherent patients for whom all other interventions to achieve adherence have failed.”
>
> Graham Parton, chairman of the UK Psychiatric Pharmacy Group, commented: “Although this small study does not tell us a great deal in terms of the effectiveness of using financial incentives to improve adherence, it does raise the premise that it could be an attractive option and is certainly worth exploring.”
>
> David Taylor, chief pharmacist, South London and Maudsley NHS Trust, added: “There will be numerous viewpoints on the ethics of such a practice but it would be best first to establish whether or not the practice is effective — as with any other untested intervention. The ethical standpoint is partly determined by the likely outcome. This study does not inform debate in this respect.”
>
>Financial incentives are done all the time in drug trials in the US. Just listen to your favourite AM radio station and you'll get ads for clinical trials and "payment and compensation up to..."
Its the non-payment aspect of the system I sometimes wonder the ethics -- frequently Phase II drug trials are conducted all over the world, in patients in developing parts of Eastern European, Southeast Asian, Carribean, African countries, on people who have desperation for medication and frequently little compensation.Its the Phase III trials that are conducted in areas of high Western medicine and are probably compensated in a greater fashion.
This may stray a bit from the subject but it draws some parallels I think
-- tidings
Posted by Phillipa on January 6, 2007, at 23:14:36
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by laima on January 6, 2007, at 22:48:55
Laima someone just posted a link on seroquel in prisons and on the street sick behavior in my opinion only . I can't imagine it. But then I'm not a drug seeker. Hope this is civil. I think it's something that needs to be studied immediatedly as atypical antipsychotics are thought of as not being addictive or abused. And your earlier question. No no no to antidepressants with a needle point well made. Love Phillipa
Posted by Quintal on January 6, 2007, at 23:18:36
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by laima on January 6, 2007, at 22:47:49
>I've had experiences like this numerous times:
>"Heart palpitations? No, you don't have heart palpitations- it's not one of the side effects on the list." (Note in chart: patient thinks she has heart palpitations.) Etc.Hmmm..... according to my learned Dr. the rash covering my arms and legs that appeared while re-starting Lamictal was actually caused by Personality Disorder Unspecified (Asperger's Syndrome is a more likely explanation according to Prof. Quintal). That's what she filed this symptom under in any case while advising me to raise the dose in the hope that would make it disappear because "Lamictal has been beneficial in the past".
>Imagine you, mental patient, knowing zyprexa's generic name. Bet you startled the young doctor :)
I certainly did and gave him a piece of my mind about prescribing antipsychotic drugs for anxiety that responds well to benzodiazepines (he was suggesting Zyprexa as a safer alternative to clonazepam and Prozac). He still maintained Zyprexa has fewer potential side effects than benzos (I'm guessing Eli Lily told him that) and discharged me, presumably because his ego was dented and he wanted to avoid any potential future injury.
Q
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