Johnson & Johnson is negotiating with federal authorities over language that might be used in dozens of civil lawsuits regarding abnormal breast development and milk production, sometimes in boys, resulting from its antipsychotic Risperdal. The Wall Street Journal says the feds want J&J to acknowledge it downplayed relevant data.
Treating one disease by causing another is actually a pretty mainstream therapeutic strategy in medicine – and especially psychiatry. The idea is to use a milder or temporary disease to treat a more severe or permanent one. In a recent development neuroleptic/antipsychotic drugs are being given to tens/hundreds of thousands of over-active children (aka ‘bipolar’). Parkinson’s disease certainly puts a stop to hyperactivity!
Researchers in Germany, China and Australia teamed up to find, through a meta-analysis of research pertaining to 1045 patients receiving antipsychotics, that augmentation with benzodiazepines did not improve outcomes. The authors recommend that benzodiazepines should be considered only for “ultra short-term sedation of acutely agitated patients but not for augmentation of antipsychotics in the medium- and long-term pharmacotherapy of schizophrenia and related disorders.”
French researchers looked at the outcomes of 467 “antipsychotic drug-naive” patients six months after a first psychotic episode (and treatment with medication), finding that the outcomes were heterogenous. A lower initial level of functioning and negative symptoms were the best predictors of worse outcomes. The sole predictor of rapid improvement, however, was employment. Results appear in Acta Psychiatrica Scandinavica. Abstract →Discuss →
Chinese researchers find, in a literature review for the International Journal of Endocrinology find an increased rate of osteoporosis among people with a schizophrenia diagnosis, and conclude that that increased risk is secondary to hyperprolactinemia caused by antipsychotics.
In previous posts in this series, I noted that the standard treatment of conditions labeled as schizophrenia (and related disorders) is to start neuroleptics early and to continue them indefinitely. This is based on the belief that untreated psychosis is bad for the brain and that relapse is much higher when the drugs are stopped than when they are continued. The rationale for this approach, and my discussion of the limitations of these assertions, were the topics of previous blogs in this series. In this final post I want to discuss how realistic this paradigm of care is. Full Article →
For the past 20 years, there has been a prevailing concern in psychiatry that psychosis is bad for the brain. When I read Anatomy of an Epidemic, this was one of my most pressing concerns; if I suggested to my patients that they pursue other treatments before starting drug treatment, was I helping or harming them? Full Article →
British researchers find that a 10% increase in pain medication resulted in a dramatic reduction in the use of antipsychotic and other medications. “When people with dementia are showing distress reactions this may be due to them experiencing pain or discomfort, yet too often rather than trying to identify and relieve this symptom they are needlessly given anti-psychotic drugs to calm them and keep them quiet,” said the head of quality and dementia care for Four Seasons Health Care, which conducted the (non-peer reviewed) study.
The Cochrane Library reports that “many older people with Alzheimer’s dementia and NPS (neuropsychiatric symptoms) can be withdrawn from chronic antipsychotic medication without detrimental effects on their behavior… the results of this review suggest that discontinuation programmes could be incorporated into routine practice. However, two studies of people whose agitation or psychosis had previously responded well to antipsychotic treatment found an increased risk of relapse or shorter time to relapse after discontinuation.”
A major research group mentions in a paper published in an academically rigorous psychiatric journal (and I get it that some readers consider that an oxymoron) the possible influence of super-sensitivity on increasing the risk of relapse when neuroleptic drugs are stopped. Yet those of us who raise this as a reason to moderate our use of these drugs are considered biased or scientifically naive.
The label of schizophrenia has a chilling ring. It carries with it the suggestion of a wrecked and wretched life. It is also a diagnosis that is notoriously difficult to shed. For this reason, the diagnosis of schizophrenia should not be applied lightly and not without a thorough understanding of the patient’s family and wider circumstances. Full Article →
Yesterday I attended psychiatry grand rounds, where Andy Miller presented his latest research. Andy has been a pioneer in the field of psychoneuroimmunology and an exponent for the view that major depression reflects systemic inflammation. (I have published a review of this literature recently in Frontiers in Psychology which is available for download). Full Article →
Martin Harrow and Thomas Jobe have a new article coming out in Schizophrenia Bulletin that I wish would be read by everyone in our society with an interest in “mental health.” Harrow and Jobe, who conducted the best study of long-term schizophrenia outcomes that has ever been done, do not present new data in this article, but rather discuss the central question raised by their research: Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Or does it hinder it? Full Article →
Psychiatrists at the University of Minnesota forced a young man into a profitable study of antipsychotic drugs over the objections of his mother, who desperately warned that his condition was deteriorating and that he was in danger of killing himself. On May 8, 2004, Mary Weiss’ only son, Dan Markingson, committed suicide. A petition to the governor of Minnesota now asks for an investigation. Full Article →
Cross-sectional analysis by the University of Maryland and Johns Hopkins University of 456,315 youths enrolled in Medicaid between 1997 and 2006 finds that the use of antipsychotics skyrocketed up to 12x, “and reflects”, according to the authors, “increased medication use for behavioral problems.” The results appeared in Psychiatric Services this month.
A review of research on antipsychotic medications as an adjunctive treatment for depression published this week in PLoS Medicine finds that the widespread practice produces either no benefit or a very small to moderate benefit on quality of life, while also being linked to adverse events such as akathisia, sedation, metabolic effects and weight gain. The authors urge that although clinicians may observe very small to moderate improvement of symptoms, “the lack of benefit with regards to quality of life or functional impairment, and the abundant evidence of potential treatment-related harm” suggest caution.
Researchers in London and Spain, in a prospective, randomized, study of long-term (3 year) effects of first- and second-generation antipsychotics on neurocognition in 79 patients following a “first episode of schizophrenia spectrum disorders”, find that “haloperidol, olanzapine, and risperidone have not demonstrated substantial neurocognitive effectiveness.” Results appeared online in Psychopharmacology on March 2, 2013.
Researchers in China find an acute reduction in white matter in the frontal lobe following six weeks of antipsychotic treatment for “first-episode schizophrenia”. Results appear in Psychological Medicine.
Psychotropic medications, including short-acting benzodiazepines, strongly increase the frequency of falls in the elderly, according to research from the Netherlands published in Maturitas: The European Menopause Journal.
Annals of Pharmacotherapy reports in a study of patients undergoing mechanical ventilation that 39% were given antipsychotic medication to prevent or treat delirium despite a lack of evidence to support its use. Monitoring for adverse side effects was infrequent. Results appeared online February 5, 2013.
In the business of clinical trials, the most valuable commodities are the research subjects. Filling clinical trials is hard, and filling them quickly is even harder. That’s why in 2000 a clinical investigator told the HHS Office of the Inspector General that research sponsors were looking for three things from research sites: “No. 1—rapid enrollment. No. 2 — rapid enrollment. No. 3 — rapid enrollment.” Full Article →
A google link to a Forbes magazine article titled “Psychiatric Drugs, Not A Lack Of Gun Control, Are The Common Denominator In Murderous Violence” now leads to a page on the Forbes website that says “Oops!”
The killing of 20 children and six adults in Newtown has triggered a search for some way of preventing these kinds of tragedies. The focus has been on gun control, video game violence and a registry of persons diagnosed with … Full Article →
In response to the Sandy Hook Elementary School shooting, ISEPP, a non-profit mental health research and education network, issues a statement calling for a Federal investigation into the link between psychotropic drugs and mass murder.