A “not otherwise specified” (NOS) diagnosis is often used when an individual may have some symptoms related to a psychiatric diagnosis but does not meet enough criteria to warrant a full diagnosis. A new study, published online ahead of print in Psychiatric Services, reveals that the proportion of mental health visits resulting in such NOS diagnoses rose to nearly fifty percent, and that these diagnoses do not result in more conservative psychiatric drug prescriptions.
With the American Medical Association (AMA) declaring its opposition to direct-to-consumer (DTC) drug advertising, Martha Rosenberg asks, did DTC increase the number of people who have "diseases"? "’Are there periods of time when you have racing thoughts? Fly off the handle at little things? Spend out of control? Need less sleep? Feel irritable? You may need treatment for bipolar disorder,’ read print ads in major magazines for Seroquel when it was first approved for bipolar disorder. Of course the person with racing thoughts could also just be drinking too much coffee or be experiencing stress at work.”
Adverse effects from psychiatric drugs account for almost one in ten adult emergency room visits related to prescription medications and one in five of these visits result in hospitalization.
The results of epidemiological studies of the prevalence of hallucinations strongly imply that psychosis and schizophrenia exist on a spectrum, according to the Scientific American. This suggests “that the standard treatment for a psychotic episode might be due for an overhaul.”
ServiceNet, a mental health and human service agency in western Massachusetts, received a three year, two million dollar grant to launch a program designed to support young adults who have recently experienced their first episode of psychosis. The Prevention and Recovery Early Psychosis (PREP) program is funded by the Massachusetts department of mental health and is designed to treat psychosis as a symptom, not an illness, resulting from other health problems, substance abuse, trauma, or extreme stress.
In the third major verdict of its kind, drug giant Johnson & Johnson was ordered to pay Nicholas Murray, a 21-year-old Maryland man who grew female breasts while taking the antipsychotic Risperdal. The company failed to warn doctors, patients, and regulators of the risk of abnormal breast development in young males and now faces about 5,400 lawsuits involving the drug.
The Washington Examiner reports that the manufacturer of the antipsychotic Abilify is seeking FDA approval for digitized pills that would alert doctors if patients fail to take their drugs on schedule.
The German news agency DW features a video report on whether cannabidiol, an active substance derived from marijuana, can help relieve the symptoms of schizophrenia.
I was a psychiatrist who participated in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). Although I welcomed the positive headlines that heralded the study’s results, the reports left me with mixed feelings. What happened to render the notion that talking to people about their experiences and helping them find jobs or go back to school is something novel?
Robert Neugeboren, who “spent most of his adult life in institutions, often subject to isolation, physical punishment and numbing medication,” was “a celebrity of sorts in the world of the 'mentally ill' [sic]: a survivor of the horrors of mistreatment, a case history for those who point to the positive effects of kindness and talk therapy, and, perhaps most of all, the embodiment of the bottomless mystery of the human mind.”
In a Science Update, the National Institute of Mental Health (NIMH) reports that steps are already being taken by Medicaid services to implement “coordinated specialty care” (CSC) in response to the RAISE study released last week. “The RAISE initiative has shown that coordinated specialty care for first episode psychosis is better than the standard care offered in community clinics. However, covering the cost of coordinated specialty care can be challenging. When Medicaid agrees to pay for effective treatment programs, patients in need benefit.”
The percentage of seniors in the United States prescribed potentially deadly antipsychotic drugs increases with age. A new study reveals that in the face of serious risks of strokes, fractures, kidney injuries, and death, over seventy-five percent of seniors given antipsychotics do not have a diagnosis for a mental disorder.
At CounterPunch, Joseph Natoli connects Big Pharma, mass shootings, and rampant inequality. He writes: “The Brave New World soma strategy to deal with a population that, were they not doped up, might violently disrupt that brave new world, is useful if a society is ‘creatively destroying’ a growing number of its population each day. While the poor have daily evidence of their poverty, a collapsing middle class live in the illusion that they are middle class and just a short distance, not from ruin, but from fame and fortune. They are, in short, heading for a catastrophic break-down. Big Pharma is already set to give us all a ‘soft landing.’”
Dr. Mickey Nardo adds to the ongoing discussion about the RAISE study results. He writes: “If there is ‘spin’ in the reporting of this study, we need to know about it. I personally think that it’s more important for RAISE to be reported completely and honestly than whether it comes out like they [or I] want it to come out. We don’t need some sanitized version of RAISE to tell us we need to turn our attention to a full bodied approach to the treatment of First Episode psychotic patients. We all already know that. What we do need is to have our confidence restored in our research community – that they will honestly and clearly report their findings whether they are clean as a whistle or an unholy mess.”
Neuroskeptic weighs in on the controversy over the lack of antipsychotic dose data in the RAISE study and the misleading media coverage. He points out that one of the treatment interventions was a computerized medication management system called COMPASS, which recommends doctors use lower doses than they otherwise might.
Last Tuesday, The New York Times and several other outlets (including Mad In America) reported on the highly-touted results of a study on psychosocial treatment for people with first-episode psychosis. Now, claims made about the study, which the ‘Times called “the most rigorous trial to date,” are coming under increased scrutiny.
This week the drug monitoring and patients' rights website, RxISK, launched the Centre for Medication Withdrawal, a page dedicated to establishing what causes dependence and how to treat it.
Writing on his 1 Boring Old Man blog, Dr. Mickey Nardo reflects on the media frenzy around the RAISE study and asks why the prescription data has not been released. He adds skepticism about the political motives of the potentially overblown results, which he sees as a clear push for increased mental health funding.
A California jury ruled that Johnson & Johnson’s Janssen Pharmaceutical and a psychiatrist are responsible for the death of 25-year-old Leo Liu. During a clinical trial for Risperdal, Liu died of a heart injury that was “further complicated” by the drug and ignored by the study doctors. Janssen was found 70% responsible for Liu’s death and ordered to pay $5.6 million to the family.
Yesterday, the New York Times reported that schizophrenia patients in an experimental treatment program (RAISE) who experienced better outcomes had been on lower doses of antipsychotics than normal. However, the article published in the American Journal of Psychiatry on Tuesday did not divulge any data on the varying antipsychotic drug doses in the different study groups.
Results of a large government-funded study call into question current drug-only approaches to treating people diagnosed with schizophrenia. The study, which the New York Times called “by far the most rigorous trial to date conducted in the United States,” found that patients who received increased drug counseling along with individual talk therapy, family training, and support for employment and education experienced a greater reduction in symptoms, were more likely to resume work and school, and reported a higher quality of life than those receiving current standard treatments.
In response to the excellent series of Risperdal articles by Steve Brill in the Huffington Post, Shezad Malik MD JD writes in the Legal Examiner that “Johnson & Johnson is exposed to more than 1,300 gynecomastia personal injury and product liability lawsuits over the failure to warn about Risperdal gynecomastia side effects in boys.” He adds that “as of today, there are over 10,000 Risperdal unfiled claims waiting in the wings.”
The University of Minnesota recently announced that it is ending the controversial practice of recruiting study participants from patients involuntarily being held in their psychiatric unit. In a commentary for Minnesota’s Star Tribune, bioethicist and MIA contributor Carl Elliot reports that the university has still not apologized to the patient who spoke out against this practice. Instead, “the university has done its best to discredit him.”
The Psychiatric Advisor reports on new research from King’s College London that suggests that antipsychotics can cause serious harm to people with Parkinson’s. According to the research: “The group that was treated with antipsychotics were four times more likely to have died following three to six months of treatment than those who did not receive any antipsychotic medication, the researchers reported in the Journal of Medical Directors Association. In addition, those on antipsychotics were also more likely to experience cognitive decline, worsening of Parkinson’s symptoms, stroke, infections, and falls.”
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