Connecting respectfully with a patient, earning trust are primary professional duties

via Medical News:

Psychotic experiences ‘not always pathologic’

a few excerpts:
“In line with the cognitive model of psychosis, the High UE group demonstrates that it may not be the anomalous experiences in and of themselves that are pathological, but one's cognitive interpretation of these aberrant experiences that differentiates between adaptive and pathological progression,” the researchers write in Psychiatry Research.

“In particular, one’s level of certainty in the appraisal of unusual experiences may be more salient in determining the psychopathological relevance of these experiences than their frequency.”

“The association between the interpersonal dimension of schizotypy and well-being is consistent with previous evidence, which indicates that this domain is most closely associated with poor quality of life,” comment the researchers.

“This research may help broaden our understanding of adaptive cognitive interpretations of unusual experiences, which may be applied to the treatment of individuals in the early phases of psychosis.”

read here

A MadMother's analysis:

One's appraisal and interpretation of personal experiences, unusual or not, is influenced by one's interpersonal relationships. How individual family members and members of one's social groups respond and/or react to an individual ALWAYS matters. In the publicly funded social service mental health treatment system, the unusual experiences this article is discussing are commonly "medically treated" automatically due to a belief that such experiences are indicative of the person having a brain disease that must be "medically treated"; or worse, controlled and medically treated under color of law. Failure to mention, or even attempt to explain that social, political and environmental factors influence how the person having the unusual experience even interprets the relevance of the experience, is strange to say the very least. Obviously, how a person interprets unusual experiences helps to determine the relevance of the experiences themselves. Equally obvious, no one has experiences unusual or not that cause others concern in an intrapersonal vacuum.

I would posit that "The association between the interpersonal dimension of schizotypy and well-being is...most closely associated with poor quality of life" because other people's responses, particularly negative ones like fear and revulsion, and other non-supportive biases and beliefs would influence the interpretation of whether or not the experience has psycho-pathological relevance, but also the social and political consequences of sharing that one has unusual experiences with others can literally be fatal.

Sharing that one has such experiences is a risk because mental health advocates, psychiatrists and mental health professionals have been "educating" the general public that these experiences are symptomatic of a person having a genetic, underlying neuro-biological condition, i.e. an incurable brain disease.  Many also claim the hypothetical psychiatric disease prevents a person from realizing they have the disease. Although this hypothetical etiology for psychiatric diagnoses has yet to be empirically validated, it has become the theoretically "Evidence Based" or "Best Practice" foundation for clinical standards of care in widespread use. Indeed, it is the only "help" available to many who seek help; particularly those on Medicaid seeking help from publicly funded mental health clinics. The disease hypothesis is the fraudulent claim underlying billions of dollars of Medicaid Fraud that has been committed; fraud that continues unabated in spite of successful lawsuits and massive penalties being levied. When used in standard clinical practice, this fraudulent claim called "psycho-education;" another tool used to manipulate and control patients in order to maintain treatment compliance, "for their own good."  Successful treatment is redefined to mean compliant with treatment; treatment outcome is not a factor considered when declaring a patient to be successfully treated. 

If one is taught that a psychiatric diagnosis of schizophrenia means the diagnosed person has a brain disease that has no cure, I imagine believing the claim would influence the interpretation of what unusual experiences mean to a person who has the experiences, and to the people who care about them. What I do not understand is how accepting a hypothetical etiology for psychiatric diagnosis on faith, i.e. unsupported by definitive empirical evidence; can conceivably justify the gross Human Rights violations that are common in the mental health treatment system. How any doctor (or anyone else) can believe using coercion and other social control tactics while virtually ignoring the Ethical Guidelines for Informed Consent of the medical profession, i.e.violating a person's Human Rights, can be justified simply by claiming this egregious unethical behavior is motivated by an altruistic intent, escapes me entirely.

That fact that unethical and abusive methods are not only tolerated, but are considered acceptable treatment methods that are commonly used in standard practice, belies the claim that psychiatry is a medical specialty. Coercion, deceit and abuse of power and authority are social and political control strategies, not ethical medical practices and procedures! Bio-medical psychiatry is based upon a yet to be empirically validated hypothesis, and relies on methods of social and political control that violate the Human Rights of psychiatric patients, these practices are accepted and widely used--even Court Ordered without requiring any evidence that meets the Rules of Evidence standard that is legally required for EVERY other type of legal proceeding.

The fact that doctors and other medical professionals use social and political control strategies, does not change the nature of what is being done to people in distress by mental health professionals. Abusive behavior and social control strategies are not magically transformed into acceptable or even ethical behaviors simply because a medical professional exhibits them in a professional capacity acting under color of law. These well known standard practices in all likelihood increase the risk that unusual experiences will be misconstrued by the person having them and by others; and intentionally or not, will exacerbate the person's distress.  These are abusive Standards of Care which erect barriers that inhibit respect, trust and empathy. Without trust, therapeutic relationships are improbable, if not impossible. Lack of positive relationships, further increases a person's risk for experiencing psychopathology (and iatrogenic harm). Whether a relationship is positive or negative is not the sole responsibility of the person in distress, or the helping professional. However, I believe that connecting respectfully with a patient and earning the trust of that patient, particularly one who is in distress, are primary ethical duties of a mental health professional. A professional should never act as if they are due any respect or trust that has not been earned through interaction with the patient in distress; much less, diagnose the person with anosognosia for not blindly trusting their medical expertise, or respecting their medical authority... 

via TheRSA:

Criticism of Thomas Insel's TED Talk: Toward a new understanding of mental illness

via TEDTalks:

Near the end he says, "Now to be clear, we're not quite ready to do this. We don't have all the facts. We don't actually even know what the tools will be, nor what to precisely look for in every case to be able to get there before the behavior emerges as different. But this tells us how we need to think about it, and where we need to go."

There is no evidence that ANY psychiatric diagnosis is caused by an underlying disease pathology, no "brain disease" has ever been identified in any person alive or dead; making Insel's suggestion at the very least, premature. It is more of a statement of Insel's personal belief in the biological hypothesis of "mental illness." His speech is more a promotion for the unethical, but lucrative relationship between the American Psychiatric Association and the pharmaceutical industry.

via Integral Options Cafe:

"This video represents what is so painfully wrong about the medical model of mental illness. TED should be ashamed of promoting such patently misleading and financially motivated crap." here

via Neuroautomaton:

The TED Model of Mental Illness: Thomas Insel
an excerpt:
"In other words, Insel’s “early identification and prevention” premise is completely unsupported by the reality. In fact, the “evidence” he uses to support this strategy for going forward (from a very special case of childhood-onset schizophrenia) may have no correlate in very common and disabling disorders like depression. Even if we could implement society-wide brain scans at an early age, there’s a very good chance that there won’t be anything useful to discover there for predicting the course of common mental disorders." here

Mindhacks Blog Deeper into genetic challenges to psychiatric diagnosis

For more on the "science" behind the disease model of schizophrenia see Mary Boyle 'Schizophrenia' and genetics: does critical thought stop here?

PCCS Books presents Mary Boyle 'Schizophrenia' and genetics: does critical thought stop here?

via PCCS Books on youtube:
In a presentation made in 2004, Mary Boyle carves through the bad science, lack of balanced reporting, and sheer lies that provide the so called 'scientific' evidence for a genetic link to 'schizophrenia'.

via PCCS Books website:

Your Independent Mental Health Publisher

• Dedicated to person-centred and experiential approaches
• Radical, critical psychology and psychiatry
• Survivor & service-user perspectives
• Promoting the demedicalisation of distress

PCCS Books on twitter

PCCS Books Open Group on facebook

Prosecute Psychiatrists

via the OC Register Letters to the editor:

Prosecute psychiatrists  

GARDEN GROVE, Clay Bock: The deadliest mass murder that has ever occurred in Orange County ends the lives of eight wonderful people, most of whom are in the prime of their lives. Hundreds of family members and their friends lives are terribly damaged forever after the loss of their loved ones. As it turns out, as in just about every one of these bizarre, brutal acts of violence, Scott Dekraai was in the hands of a psychiatrist and on psychiatric drugs. 

The second-deadliest O.C. mass murderer, according to the newspaper, Edward Allaway, also had a long history of psychiatric “treatment” before he killed seven people at Cal State Fullerton in 1976. There are hundreds of those treated by psychiatrists in between, including the man who killed innocent shoppers with the sword in Irvine or Eric Harris at Columbine.  

Psychiatrists know that these drugs cause a certain number of people to become violent. Here is a list of a few of the side effects for their drugs from the National Institute of Mental Health website: Irritability, aggressive or violent behavior, acting without thinking, extreme increase in activity or talking, sudden or unusual changes in behavior and even suicide.


If Dr. Conrad Murray can be prosecuted for Michael Jackson’s death due to misapplication of prescription drugs, it is time to prosecute psychiatrists behind these mass murderers. read here

Neuroleptic Origin: 1955–60;  French neuroleptique, equivalent to neuro- neuro- + -leptique < Greek lēptikós disposed to take, equivalent to lēp- (verbid stem of lambánein to seize) + -tikos -tic; see -lepsy  via Dictionary.com 

It is a relatively new concept for people with a diagnosis of schizophrenia to be considered "violent."  Violence has only been associated with a diagnosis of schizophrenia in the last 50 or so years----after the introduction of neuroleptic drugs.  It is significant that this shift in perception occurred around the time it became apparent that people treated with what were then, relatively new drugs, the neuroleptic, or "antipsychotic" drugs became aggressive or violent.   The neurological and cognitive impairment many attribute to the psychiatric diagnosis of schizophrenia are in reality caused by the teratogenic, neuroleptic drugs.

When one considers how little we know about the pathophysiology of schizophrenia for which these nerve-seizing or "nerve affecting" drugs were initially prescribed; it is more than a little frightening.  The neuroleptic drugs have been used for 60 years, and we know they cause cardio-vascular, metabolic and neurological dysfunction; we know that neuroleptics cause intellectual, neurological, cognitive and physical impairments, that are disabling; and can cause sudden or early death.  Neurological impairment was not identified as a symptom attributed to the progression of schizophrenia before the advent of these teratogenic drugs; but it is listed along with aggression and violence and now attributed to the diagnosis of schizophrenia; which seems less than acurate, or honest to say the the very least. 

via The Lancet:

“Why are the mentally ill still bearing arms?”

an excerpt:"As but one example, the second edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 1968, redefined paranoid schizophrenia as a condition of “hostility” and “aggression” and projected anger in ways that encouraged psychiatrists to conceptualise(sic) violent acts as symptoms of mental illness." read           

In psychiatry, "successful treatment" is defined totally differently than in any other medical specialty. In psychiatry, successful treatment is not dependent upon diagnostic validity or the effectivenss of the treatment; it is solely based upon the patient's willingness to be "treatment compliant."

via the Journal of the Royal Society of Medicine, a personal paper asks, Does psychiatry stigmatize? The author concludes "psychiatry may have very little specific to offer" to many with a psychiatric diagnosis.  The paper asks whether it is possible that psychiatry harms some, and also agrees this is probably so, due to the limited ability to explain problems caused or exacerbated by social and environmental conditions.  read the paper here. 

via Reuters:

French psychiatrist sentenced after patient commits murder

A French psychiatrist whose patient hacked an elderly man to death was found guilty of manslaughter on Tuesday in a groundbreaking case that could affect the way patients are treated.

A court in Marseilles said Daniele Canarelli, 58, had committed a "grave error" by failing to recognize the public danger posed by Joel Gaillard, her patient of four years.

Gaillard hacked to death 80-year-old Germain Trabuc with an axe in March 2004 in Gap, in the Alps region of southeastern France, 20 days after fleeing a consultation with Canarelli at Marseilles's Edouard Toulouse hospital.

Canarelli was handed a one-year prison sentence and ordered to pay 8,500 euros to the victim's children, in the first case of its kind in France. Defense lawyers said the ruling would have serious repercussions for treatment of the mentally ill.

"If a psychiatrist lives in fear of being sentenced, it will have very real consequences and probably lead to harsher treatment of patients," said Canarelli's lawyer, Sylvain Pontier.

The court said Canarelli should have requested Gaillard be placed in a specialized medical unit or referred him to another medical team, as one of her colleagues suggested. Her stubborn refusal had equated to a form of "blindness", the court president Fabrice Castoldi said.

Gaillard had already been forcibly committed to a secure hospital on several occasions for a series of increasingly dangerous incidents.

The victim's son, Michel Trabuc, said he hoped the case would set a legal precedent.

"There's no such thing as zero risk, but I hope this will move psychiatry forward and, above all, that it will never happen again," he said.

Gaillard was not held responsible for his actions and was freed under medical supervision.

(Reporting by Jean-François Rosnoblet; Writing by Vicky Buffery; Editing by Alison Williams) here

A Seeding Trial: Side Effects of Newer Antipsychotics in Older Adults updated

Trust me I'm a Ducktor

Updated on 12-5-2012

This is a comment that I left on the Mad in America website:

Being unethical doesn’t mean it does not happen. It does. In my opinion, off label prescriptions of psychotropic drugs, particularly prescriptions which are not based on clinical trial evidence, or even minimally supported by data about the drugs’ safety and effectiveness, (which is more common than not, in psychiatry) is Human Experimentation. Calling it “Off Label” instead of calling it what it is, is deceptive; and I believe it is done to deceive. This off label prescribing is theoretically supposed to be based on actual evidence of safety and efficacy, even if it is not from drug trials; the drugs have been in use for a very long time and STILL there is not the evidence available that what is being done in Standard Clinical practice is supported by EVIDENCE. So how the hell did this become a STANDARD PRACTICE? By a using a quasi-democratic process of collaboration and consensus of a few followed by the vote of a few more.  A group of people in effect have determined that voting on their own educated opinions and reaching a consensus is how to develop an "Evidence Base" for psychopharmacology.  Consensus is evidence of agreetment, it is not a substitute for the empirical data required to ethically justify implementing any medical care standard.  It is a dishonest and not at all ethical to use a collection of subjective opinions and observations AS IF they become scientific evidence by virtue of the number or "importance" of the individuals offering them.  Subjective observation is used to SUPPORT objective information NOT replace it... What are the Standards of Care in psychiatry, ie. practice parameters, treatment algorithms, etc. if they are not science-based ethical medical standards?  What the Standards of Care in psychiatry are is an affirmative defense for allegations of medical malpractice. In effect, and in fact, Human Experimentation without the knowledge or the consent of the human participants is standard practice it's "psycho" pharmacology!  

beginning of original blog post

Recently the disappointing outcome of a study using 4 neuroleptic drugs, called "atypical antipsychotics," was reported by UC San Diego and published in the online Journal of Clinical Psychiatry.  When I first read about this study at 1 Boring Old Man's blog, something seemed seriously wrong; but I couldn't put my finger on it right away. After doing a little digging, I realized what was bothering me. It appears the study was a seeding trial, conducted in an (unsucessful) attempt to "legitimize" gain FDA approval for what is being done in standard practice, the off-label prescription use of the drugs known to be ineffective for treating PTSD, Alzheimer's Disease, and Dementia.  All four drugs have an FDA Block Box Warning for increased mortality when used to treat dementia; i.e. dementia is not an FDA approved indication for the drugs used in this trial. Another condition mentioned by the UC San Diego press release is PTSD; PTSD is not an FDA approved indication for the drugs either. In fact, PTSD is not even mentioned among the three conditions listed for intervention with this drug study at ClinicalTrials.gov.

via UC San Diego Health System:

Four Common Antipsychotic Drugs Found to Lack Safety and Effectiveness in Older Adults

some excerpts:

"In older adults, antipsychotic drugs are commonly prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications – schizophrenia and bipolar disorder. The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia, some of which carry FDA warnings on prescription information for these drugs." (emhasis mine) 

The study looked at four atypical antipsychotics (AAPs) – aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) – in 332 patients over the age of 40 diagnosed with psychosis associated with schizophrenia, mood disorders, PTSD, or dementia. (emphasis mine) 

“Our study suggests that off-label use of these drugs in older people should be short-term, and undertaken with caution,” said Dilip V. Jeste, MD, Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of the Stein Institute for Research on Aging at UC San Diego.

"Results of the five-year study led by Jeste, who is also current president of the American Psychiatric Association (which was not involved in this research), showed that within one year of treatment, one-third of the patients enrolled in the study developed metabolic syndrome (medical disorders that can increase the risk of cardiovascular disease or diabetes). Within two years, nearly a quarter of the patients developed serious adverse effects and just over half developed non-serious adverse effects." here

The FDA approved indications for the 4 drugs used in this study are here

All of the drugs used in this drug trial have black box warnings from the FDA for causing increased mortality for elderly with dementia. The UC San Diego article states, some of the drugs, "carry FDA warnings."  The actual number of participants enrolled in the trial was 406, according to the ClinicalTrials.gov website; why would the the UC San Diego announcement state there were only 332?  PTSD and mood disorders are not listed with the conditions participants were to be treated for on the Clinical Trials website; schizophrenia, Alzheimer's Disease, and dementia are the conditions listed. The only one that is an FDA approved condition is schizophrenia.  The end points were safety and efficacy, which is standard for an "investigational" drug trial, Clinical Trials.gov states this was an investigational Phase 1 trial for the first few years of the trial.  

On October 18, 2012 "Active Control" was deleted from the list of  design characteristics for this study. The responsible party, Dilip V. Jeste, and UCSD was changed to "sponsor" on the same  date.  On April 11, 2009 the Seroquel arm was discontinued, and the answer for the  "accepts healthy volunteers" question was changed from "NO" to "Yes."  A Data Monitoring Committee was also added at the same time.  On February 29, 2008 the classification for this trial was changed from a Phase 1 drug trial to a Phase 4 drug trial; The lead sponsor was changed from being listed as the NIMH to being listed as UCSD; and Dilip V. Jeste, at UCSD, was listed as now being the responsible party, usually the responsible party the lead investigator, would also be the lead author, but in this case Dilip V. Jeste, the President of the American Psychiatric Association, is said to be the lead investigator but is not the lead author.  This study started with The Veterans Medical Research Foundation as the lead sponsor, then the lead sponsor was the NIMH, and upon the study's conclusion, the VMRF is once again listed as the lead sponsor and the NIMH is listed as a collaborator. 

"The bottom line is no solid evidence-based treatment exists for psychosis or agitation in dementia. Atypical antipsychotics carry a black-box warning for increased risk of death and cerebrovascular events in dementia, although typical antipsychotics appear no safer." Thomas W. Meeks, M.D. and Dilip V. Jeste, M.D. in Beyond the Black Box: What is The Role for Antipsychotics in Dementia? 2008

via Physicians Postgraduate Press:
Use of Clinical Markers to Identify Metabolic Syndrome in Antipsychotic-Treated Patients

Hua Jin, MD; Jonathan Meyer, MD; Sunder Mudaliar, MD; Robert Henry, MD; Srikrishna Khandrika, PhD; Danielle K. Glorioso, MSW; Helena Kraemer, PhD; and Dilip Jeste, MD

J Clin Psychiatry 2010;71(10):1273–1278

10.4088/JCP.09m05414yel

Copyright 2010 Physicians Postgraduate Press, Inc.

Objective: Metabolic syndrome (MetS) is prevalent among antipsychotic-treated patients; however, in psychiatric clinics, scarce resources often limit the feasibility of monitoring all 5 criteria that are necessary for diagnosing MetS. As one goal of the MetS definition is to facilitate the clinical identification of insulin-resistant individuals, other biomarkers of insulin resistance have been explored. However, there are relatively few data from antipsychotic-treated patients, especially on the association between these markers and the clinical MetS diagnosis.

Method: We analyzed data from 196 psychiatric patients over age 40 years enrolled in an ongoing study of antipsychotic-related metabolic effects that began in August 2005. here

Black Box Warning from The U.S. Department of Health and Human Services FDA

Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances

4/11/2005

The Food and Drug Administration has determined that the treatment of behavioral disorders in elderly patients with dementia with atypical (second generation) antipsychotic medications is associated with increased mortality. Of a total of seventeen placebo controlled trials performed with olanzapine (Zyprexa), aripiprazole (Abilify), risperidone (Risperdal), or quetiapine (Seroquel) in elderly demented patients with behavioral disorders, fifteen showed numerical increases in mortality in the drug-treated group compared to the placebo-treated patients. These studies enrolled a total of 5106 patients, and several analyses have demonstrated an approximately 1.6-1.7 fold increase in mortality in these studies. Examination of the specific causes of these deaths revealed that most were either due to heart related events (e.g., heart failure, sudden death) or infections (mostly pneumonia). read the rest here

 via Physician's Post Graduate Press:

Comparison of Longer-Term Safety and Effectiveness of 4 Atypical Antipsychotics in Patients Over Age 40: A Trial Using Equipoise-Stratified Randomization

Hua Jin, MD; Pei-an Betty Shih, PhD; Shahrokh Golshan, PhD; Sunder Mudaliar, MD; Robert Henry, MD; Danielle K. Glorioso, MSW; Stephan Arndt, PhD; Helena C. Kraemer, PhD; and Dilip V. Jeste, MD

J Clin Psychiatry

10.4088/JCP.12m08001

Copyright 2012 Physicians Postgraduate Press, Inc.

Objective: To compare longer-term safety and effectiveness of the 4 most commonly used atypical antipsychotics (aripiprazole, olanzapine, quetiapine, and risperidone) in 332 patients, aged > 40 years, having psychosis associated with schizophrenia, mood disorders, posttraumatic stress disorder, or dementia, diagnosed using DSM-IV-TR criteria.

Method: We used equipoise-stratified randomization (a hybrid of complete randomization and clinician’s choice methods) that allowed patients or their treating psychiatrists to exclude 1 or 2 of the study atypical antipsychotics due to past experience or anticipated risk. Patients were followed for up to 2 years, with assessments at baseline, 6 weeks, 12 weeks, and every 12 weeks thereafter. Medications were administered employing open-label design and flexible dosages, but with blind raters. The study was conducted from October 2005 to October 2010.

Outcome Measures: Primary metabolic markers (body mass index, blood pressure, fasting blood glucose, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), percentage of patients who stay on the randomly assigned atypical antipsychotic for at least 6 months, psychopathology, percentage of patients who develop metabolic syndrome, and percentage of patients who develop serious and nonserious adverse events.

Results: Because of a high incidence of serious adverse events, quetiapine was discontinued midway through the trial. There were significant differences among patients willing to be randomized to different atypical antipsychotics (P < .01), suggesting that treating clinicians tended to exclude olanzapine and prefer aripiprazole as one of the possible choices in patients with metabolic problems. Yet, the atypical antipsychotic groups did not differ in longitudinal changes in metabolic parameters or on most other outcome measures. Overall results suggested a high discontinuation rate (median duration 26 weeks prior to discontinuation), lack of significant improvement in psychopathology, and high cumulative incidence of metabolic syndrome (36.5% in 1 year) and of serious (23.7%) and nonserious (50.8%) adverse events for all atypical antipsychotics in the study.

Conclusions: Employing a study design that closely mimicked clinical practice, we found a lack of effectiveness and a high incidence of side effects with 4 commonly prescribed atypical antipsychotics across diagnostic groups in patients over age 40, with relatively few differences among the drugs. Caution in the use of these drugs is warranted in middle-aged and older patients.    here

via ClinicalTrials.gov:

Side Effects of Newer Antipsychotics in Older Adults

Purpose

This study will compare four atypical antipsychotic medications in terms of the risk of specific side effects each of them presents in middle-aged and elderly individuals.

Condition                                                Intervention                                                   Phase
Schizophrenia                                         Drug: Aripiprazole                                         Phase 4
Alzheimer's Disease                                Drug: Olanzapine
Dementia                                                Drug: Risperidone


Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Metabolic Effects of Newer Antipsychotics in Older Patients

Detailed Description:

Atypical antipsychotic medications introduced within the last decade have been used increasingly for the treatment of several types of psychotic disorders and severe behavioral disturbances in older individuals. This trend is primarily due to a decrease in side effects caused by the new medications, as compared to conventional neuroleptic medications. There is a lower risk for developing tardive dyskinesia and extrapyramidal symptoms, both of which are movement abnormalities, with new antipsychotic medications. However, there has been a growing concern that the newer medications can cause a different set of potentially serious adverse side effects. Specifically, they may cause long-term metabolic, cardiovascular, and cerebrovascular effects, which may result in weight gain, diabetes, or stroke. This study will compare four atypical antipsychotic medications in terms of the risk of metabolic, cardiovascular, and cerebrovascular side effects that each presents in middle-aged and elderly individuals.

Participants in this open-label study will be randomly assigned to receive one of three atypical antipsychotic medications: aripiprazole; olanzapine; or risperidone. Although assignment is random, a technique that may reflect the participant's own interests or the researcher's knowledge of relevant participant characteristics will be used to assign the participant to a medication. Dosing will be determined by each participant's psychiatrist. Participants will be followed for up to 5 years to assess the side effects of the study medications, with study visits at baseline, Week 6, and every 3 months thereafter.

Ages Eligible for Study: 40 Years and older
Genders Eligible for Study: Both
Accepts Healthy Volunteers: Yes

Criteria
Inclusion Criteria:
DSM-IV diagnosis of a disease or disorder that requires treatment with an atypical antipsychotic medication

Exclusion Criteria:
N/A here

photo credit Just Ducks

Is child abuse a cause of schizophrenia?

via: King's College London:

Maudsley Debates

Is child abuse a cause of schizophrenia?

June 2006

This house believes child abuse is a cause of schizophrenia.

The 30th Maudsley Debates is on the topic of child abuse and schizophrenia, a controversial topic that has been given a lot of recent attention as a result of a review published recently by Dr. John Read and colleagues in the journal, Acta Psychiatrica Scandinavica*.

* Read, J., van Os, J., Morrison, A.P., & Ross , C.A. (2005) Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350

Speaking for the motion: Dr. John Read (University of Auckland), Mr. Paul Hammersley (University of Manchester)

Speaking against the motion: Professor Peter McGuffin (Institute of Psychiatry), Terry Hammond (RETHINK)

CHAIR: Professor Til Wykes (Institute of Psychiatry)

podcast mp3 Is childabuse a cause of schizophrenia?

Hearing Voices in Accra and Chennai: How Culture Makes A Difference to Psychiatric Experience

via Constance Cummings

via Neuroanthropology blog at PLOS Blogs 

Tanya Luhrmann, hearing voices in Accra and Chenai by Greg Downey here

via The Wilson Quarterly Beyond the Brain by Tanya Marie Luhrmann 

Update 1-16-2013 via Ruminations on Madness

Return of the Social: Rewriting the recent history of schizophrenia 

"I’ve long felt a certain ambivalence regarding Tanya Luhrmann’s work on psychosis (see, e.g., a much earlier post here).  Part of my frustration stems from Luhrmann’s disconnect, so far as I can tell, from the complexities of the user/survivor movement, and part from disappointment that  the tremendous potential latent in her topics of choice—potential, above all, to inject psychiatric discourse with the theoretical nuance I otherwise associate with contemporary medical anthropology—is so rarely realized.  Luhrmann’s latest commentary—an informal piece on the recent history of schizophrenia treatment, presumably targeting educated non-specialists—unfortunately only intensifies my frustration (and more than a touch of righteous anger) with her work.  Instead of careful attention to cracks and discontinuities, to politics and the machinations of neoliberalism,  Luhrmann sets out to tell what amounts to a surprisingly classic (and even more surprisingly uninformed) metanarrative of the ‘necessary progress’ of knowledge and freedom—knowledge advanced by scholars, and freedom, of course, for schizophrenia patients.  (Progress, admittedly, that is (always?) also a return to as Luhrmann puts it, “an older, wiser understanding of the mind and body.”) Here are a few of my complaints:

Bio-bio-bio…..gone?

"Luhrmann’s noticeably Hegelian rendering of the history of the modern psychiatric treatment of schizophrenia goes approximately like this: for much of the early 20^th century, American psychiatrists attributed the development of schizophrenia to poor mothering, and turned to primarily psychosocial therapies informed by psychoanalysis.  The 1980s, in contrast, marked the introduction of an “antithetical” discourse—biomedical psychiatry, peaking with the “decade of the brain” in the 90s—followed more recently by the synthetic ‘return of the social’.  In a particularly memorable line—one that would stun both my activist and mental health services researcher colleagues—Luhrmann announces, “It is now clear that the simple biomedical approach to serious psychiatric illnesses has failed… At least, the bold dream that these maladies would be understood as brain disorders with clearly identifiable genetic causes and clear, targeted pharmacological interventions…has faded into the mist.”  That the decade of the brain oversold itself and that biopsychiatry has—as for the last half century at a minimum—been strongly contested by activists, as well social and community psychologists and psychiatrists, is undeniable.  That biopsychiatry has “faded in to the mist”…? Let me attempt to unpack a few of the complexities Luhrmann ignores." read here

Thank You For The Ominous Long-Term Health Risks

Quack Master Jack McClellan

"Whenever a doctor cannot do good, he must be kept from doing harm."  Hippocrates

Jon McClellan, the lead researcher for childhood schizophrenia in Washington State, is a doctor who should be stopped.  He is the psychiatrist who gave my son neuroleptic and other  psychotropic drugs without consent. He repeatedly told me I had no say in treatment decisions; no say about what drugs he gave my son.  He drugged my son without consent, much less, Informed Consent; while trialing neuroleptic drugs for FDA approval; so the drugs he used were not approved for use on children.  Drugged my son over my objections, into a state of profound disability. He told me I had no say in what drugs were given to my boy, who had an IQ of 146.  It is frightening that this man is still the Medical Director of the State-run psychiatric facility for children.

Schizophrenia is a diagnosis of exclusion.  What that means is that any and all other explanations for the symptoms must be excluded.  Until this researcher got a hold of him, my son was diagnosed with Temporal Lobe Epilepsy and PTSD, the latter due to having been severely traumatized, in foster care.  Both of these can cause the symptoms which Dr. McClellan concluded were symptoms of schizophrenia.  When I asked him if he was going to do an EEG to rule out the Temporal Lobe Epilepsy; he said it was not necessary.  My protests were labeled denial, my input was dismissed; I was told I had no say.

Ultimately, McClellan put my son on Clozapine which between 1998 and 2005 was linked to 3,277 deaths in the U.S. and over 4,300 events that resulted in disability or required medical intervention, according to the data in the FDA Medwatch adverse events reporting system.  Dr. McClellan lied to me and said that since the drugs was  put back on market in the US, with mandatory blood draws, no one had died from it's use. He also told me that it was only over in Europe that anyone died at all.  This conversation happened only after he had put my son on the drug, as did all the conversations about what drugs he was using to treat my son. Like all of the drugs used by Jon McClellan, on my son, it was not approved for pediatric use for the reason McClellan prescribed them.

The reality is, no matter the diagnosis or the symptoms; this doctor had no right to use my son as a guinea pig---and he had no legal authority to drug him without my consent.  He did not have my son's consent---or his mother's permission; he did not comply with the Hippocratic oath, the ethics guidelines of the medical profession, the laws of the State of Washington, Federal Medicaid guidelines, the U.S. Constitution, or the Nuremberg Code.  There is no way in hell I would have given consent, had I been given the opportunity and actually been informed, which he did not think was necessary. Quack Master Jack, Jon McClellan, a "lead researcher" funded by NIMH, played God.

What is known and has been know about this class of drugs for decades, is that they cause iatrogenic, i.e. physician caused; diseases, neurological impairments, disability, and sudden, and early death.  These are know risks, and as such, should be information discussed prior to administration.  I found these facts out on my own, not in any conversation I had with "Dr. Jack," as he told the kids to call him.  My son, who still takes Clozapine, is unaware of these risks; no psychiatrist has discussed them with him.  McClellan used many anti-psychotics, on my son without adhering to any ethical, moral, or legal standard; knowing this, I am disgusted that this man never loses an opportunity to decry their over-use.  He had no problem using them to drug my son; without warning either my son or myself about the "Ominous Long-Term Health Risks."

It didn't matter to Quack Master Jack that he didn't have 
Informed Consent from the patient or his MadMother.

I was never asked if I wanted to sacrifice my son on the altar of corporate greed and have my son used in Drug Trials. Had I been asked, there's no way in hell I would have given consent. The TEOSS Drug Trial was a "seeding trial," the purpose of a "seeding trial" is gain FDA approval for a drug to treat a new condition, or a different population; to expand the drug market and ensure that BigPharma continues to make a killing

figuratively and literally...

It matters to this MadMother.

Does it matter to you?

Link to The Belmont Report and Nuremberg Code:


Originally published on December 17, 2010

“A Drop of Sunshine”

“A Drop of Sunshine” Film by Apama Sanyal “Schizophrenia. It may be one word, but it immediately conjures up multiple connotations – mad, incurable, violent, suicidal, chemical imbalances, crazy, a lifelong condition, an inevitable dependency on Medicines. This film questions this negative mainstream view of the condition, and wonders if an alternative destiny for a person with a diagnosis is possible. It charts out the story of Reshma Valliappan, who now lives a fulfilling life, free of medicines. The film explores a controversial, but ultimately empowering, view of the condition, which a small minority of brave psychologists and psychiatrists are beginning to embrace across the world. It also proposes a contrarian approach towards treatment for the condition, where the patient is encouraged and equipped to become an equal partner in the process of healing.”"

Val Resh blog

photo credit

Is There a Role for Clozapine in the Treatment of Children and Adolescents (Who Are Guinea Pigs)?

Can you tell the difference?

via ERIC:

Is There a Role for Clozapine in the Treatment of Children and Adolescents?

Findling, Robert L.; Frazier, Jean A.; Gerbino-Rosen, Ginny; Kranzler, Harvey N.; Kumra, Sanjiv; Kratochvil, Christopher J.
Journal of the American Academy of Child & Adolescent Psychiatry, v46 n3 p423 Mar 2007

"This article presents responses to the question of whether clozapine is ever appropriate to use in the pediatric population. Among others, Jean A. Frazier also agreed that clozapine is appropriate for use in the pediatric population. Clozapine has truly revolutionized the treatment of refractory patients with schizophrenia at any age. This agent was approved by the U.S. Food and Drug Administration (FDA) in 1989 for use in individuals ages 18 years or older with treatment refractory schizophrenia. Subsequent to clozapine, the FDA has approved a number of atypical antipsychotics for the treatment of psychotic disorders, but none to date are approved for use in children and adolescents. Despite the superior efficacy of clozapine, its use has been limited because of its complex side effect profile, consisting of hypersalivation, weight gain, metabolic abnormalities, cardiovascular side effects, sedation, seizures, and agranulocytosis. Children may be more prone to developing these side effects than adults because of developmental differences in the metabolism of this agent."

via Highbeam Business:



Is there a role for clozapine in the treatment of children and adolescents?

Article from: Journal of the American Academy of Child and Adolescent Psychiatry | March 1, 2007 | Findling, Robert L.; Frazier, Jean A.; Gerbino-Rosen, Ginny; Kranzler, Harvey N.; Kumra, Sanjiv; Kratochvil, Christopher J. | Copyright Journal of the American Academy of Child and Adolescent Psychiatry

IS THE USE OF CLOZAPINE EVER APPROPRIATE IN THE PEDIATRIC POPULATION? IF APPROPRIATE, WHEN AND HOW WOULD YOU MANAGE ITS USE IN CHILDREN AND ADOLESCENTS?

Robert L. Findling, M.D.

The question of whether clozapine is ever appropriate to use in the pediatric population is an important one. At present, according to the U.S. Food and Drug Administration (FDA), clozapine is indicated for patients with treatment-resistant schizophrenia and may be prescribed for patients with psychotic illnesses to lower the risk of suicidal behavior. The reason that clozapine is reserved for use with patients who are not responsive to other interventions is because clozapine therapy can lead to agranulocytosis, seizures, and myocarditis. Clozapine is currently not approved for use in pediatric patients.

Despite these facts, treatment with clozapine is considered for some children and adolescents who are suffering from severe, disabling psychopathology who do not respond to or cannot tolerate first- or even second-line medication interventions for which clozapine therapy may be considered. Although the use of clozapine has been described in several pediatric patient populations, the best evidence supporting its use in children or adolescents are in youths with treatment-resistant psychotic illnesses or in young people with treatment-resistant bipolar illness (Findling et al., 2005). It should be emphasized that the use of clozapine has not been rigorously studied in aggressive youths with primary diagnoses of disruptive behavior disorders. Because of this lack of evidence and the side effect profile of clozapine, use in aggressive patients with primary diagnoses of disruptive behavior disorders is not recommended. Although some of the data relating to clozapine's use in the young may not be methodologically stringent or extensive, what information is available does suggest that clozapine may be helpful when reserved for use in some seriously ill patients with treatment-resistant schizophrenia or bipolar illness.

In short, the answer to the question posed is "yes." Clozapine therapy may be appropriate for some pediatric patients with psychotic disorders or bipolar illnesses who do not respond to other forms of pharmacotherapy.

Now that the diagnoses of the patients for whom clozapine therapy may be beneficial have been identified, the more complicated and difficult issue is the question of at what point in the course of treatment does one consider clozapine therapy for patients with psychotic disorders? When only typical antipsychotics and clozapine were available, the time at which one may have considered clozapine therapy for patients may have been clearer. Patients who failed treatment with one typical antipsychotic often failed treatment with another. Thus, a patient who failed to respond to two typical antipsychotic medication trials may have been considered an acceptable candidate for clozapine therapy. However, in this era of multiple pharmacologically distinct first-line atypical antipsychotics (as well as continued availability of typical antipsychotics), it is not clear when one may consider the use of clozapine for young patients with treatment-resistant schizophrenia. In the absence of definitive data, clinical judgment and patient/family choice become the key factors. It may be suggested that one could consider only clozapine for a patient who had clearly failed to have a substantive reduction in psychopathology after treatment with at least three different antipsychotics (two atypicals and one typical). As part of the general evaluation of patients who are failing to respond to therapy, it is strongly recommended that one considers the many reasons that patients may not be responding to treatment. A careful diagnostic reassessment is often prudent. In addition, environmental factors and possible nonadherence to prescribed medications should also be considered. At that point, I would think about discussing the option of clozapine therapy with the patient's guardians and, as appropriate, with the patient.

Expert consensus guidelines have recently been published for pediatric bipolar illness … here

All due respect to the "experts," without clinical trial data, or data from real world clinical practice, their consensus "opinion" is not an ethical treatment recommendation. Without definitive evidence of Clozapine being effective, not simply "efficacious;" and definitive evidence that the benefits out-weigh the tremendous risks for disabling adverse effects, how can a group of "medical scientists" ethically recommend a treatment based only upon agreement? The Guideline is based on a consensus of agreement and was published in a so-called "peer-reviewed professional journal" in 2007, it was developed from answers on a survey! Subjective observation,and/or subjective opinion is considered to be the weakest most unreliable 'evidence' in scientific research, for this reason, it is used to support empirical clinical data; it is not a substitute!  Expert Consensus Guidelines are a commercial product, they are not a derived from scientific research or clinical trial data.

This "expert" guideline was issued one year after my son had become an adult. By his 18th Birthday, he had been taking Clozapine for 5 years...without consent and in spite of my protests---The psychiatric "doctors" refused to discuss lowering the dosages, or the profound deleterious adverse effects my son was experiencing. One actually told me it doesn't matter what my son's diagnosis is/was.  Both of them said I had no say; like Jon McClellan had.  Supposedly, since my brain-damaged son was over the age of 13, my informed consent wasn't needed...

What do you want to bet the clinical trial data these "experts" did have, did not support their "expert" opinions; which is why they took surveys to to write these marketing manuals, er. I mean guidelines. 

If these "doctors" had data to support their opinion, they wouldn't have had rely on the weakest data in scientific endeavors that other fields of scientific research, use to support empirical data---not as a substitute or a replacement!

I must admit I am extremely biased. I bear witness to how my precious child was treated like a guinea pig by a psychiatric research 'expert' who repeatedly traumatized, and ultimately disabled him. My son is struggling to recover from what he describes as "torture," being "traumatized over and over and over" by the people who were "supposed to be helping me." Mental health and social service 'professionals' continue to treat my son as if his diagnosis lowered his worth as a human being, as if his psychiatric diagnosis somehow means my son is unworthy of respect. Traumatic treatment experiences are denied altogether, it's demoralizing to be continually invalidated by mental health and social service professionals who are supposed to be helping, but instead repeatedly traumatize, then invalidate my son entirely---by denying therapeutic treatment for his profound iatrogenic injuries and impairments caused by the biological "treatment;" and the emotional injuries caused by mental health 'standards of care', i.e. manipulative, coercive mistreatment. 

Suzanne Beachy - What's Next For The Truth

via TedxColumbus:

Suzanne Beachy/ What's Next for the truth

Any diagnosis of mental illness results in a complicated and uncertain fate for those it strikes. When you lose a son as a result of such a diagnosis, it ignites a search for answers. Suzanne Beachy has gained a perspective on life as a result of her loss but is still asking, what is the truth?

About Suzanne:

A mom since 1980, Suzanne Beachy began packing school lunches for her son Jake in 1986. Twenty-four years later, she is still packing school lunches for her young kids, Natalie and Collin. In addition to the usual mommish duties of cleaning up messes and attending to the needs of young digestive systems, Suzanne has worked for pay as a music librarian, bass player, stage hand, professional letter writer and copy editor, and as a partner in her husband Tim's building business. Every other Friday, she works for free as a lunch lady at her kids' school.

About TEDx, x = independently organized event 

In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized. (Subject to certain rules and regulations.)