Monday, August 3, 2020

Comments by shook

Showing 25 of 25 comments.

  • My general critique and agreement of Whitaker’s take on things is more eloquently stated by another here:

    Antipsychotics in acute psychosis:
    Delayed-onset hypothesis of antipsychotic action: a hypothesis tested and rejected. Agid O, Kapur S, Arenovich T, Zipursky RB

    The first link is a pretty cool debate response by Allen Frances who is no friend of the establishment — especially with his scathing attacks on big pharma and the DSM-5. But he sees right through Whitaker’s sleight of hand. If you read Anatomy of an Epidemic, Whitaker cites Harrow’s following of 60 or so patients on antipsychotics and then makes a huge generalization about causation and medications. This is not a placebo or randomized controlled study. You can’t make any conclusions about meds from Harrow’s study. In a follow-up paper they admitted as much. Correlation is not causation and it is that leap that is made throughout that book again and again.

    I also cited a paper way up above that shows people with the diagnosis of Schizophrenia live longer on antipsychotics. It was a country wide study (Sweden) that also showed how dangerous Benzos are. It is really hard to argue with those findings.

    The genetics testing led to a finding that the histocompatibility complex that modulates the immune system was found to be a major player in people with the diagnosis of Schizophrenia. There is now active research to try and figure out if the immune system is attacking dendritic cells in the brain at the time of second phase pruning in adolescence (a time when a majority of first psychotic breaks happen).

    A tiny minority are housed in state hospitals. Our biggest mental healthcare provider is the prison system.

    Sorry, this post answers several posts.

  • Sa, again, these actions have happened. This would be the scenario: a man comes to a psychiatric ward from medicine stabilized after gouging his eye out with a pencil in his home. He is actively psychotic, stating there is a transmitter in his eye and the government has him under surveillance. He is aggressive towards staff. I cited a study up above done by an entire country finding antipsychotics lower all-cause mortality in people with the diagnosis of Schizophrenia.
    Again, there are degrees of sickness here that I think are just not appreciated and perhaps can’t be appreciated unless seen first-hand. Antipsychotics decrease the length of psychosis. This guy is getting an antipsychotic. I’m not locking him in a room and waiting for the psychosis to go away. You can argue two points here: Antipsychotics decrease the length of psychosis and they decrease all-cause mortality in people with Schizophrenia, but I would challenge you to cite those studies.

    Frank, as to your points, there have been some real breakthroughs in 2016, especially with the genetics of Schizophrenia. It is early, but I think we are headed there.

  • Good points. The data for long acting drugs could definitely be better. I agree.
    There are better studies to back up your claim on psychotherapy (Cognitive Behavior Therapy for People with Schizophrenia by Morrison et al is one). The meta analysis you cite is on very old studies and the fact they didn’t do a number needed to treat analysis is troubling as the people who drop out of the studies are going to skew to the frustrated or the non-responsive in my opinion, despite their claims to the contrary.

  • I think you misunderstand my meaning. Those patients actually did those things. Again, Schizophrenia describes a heterogeneous population of probably 30 or 40 discrete disease processes. It can be much more severe than I think most people realize. I’ve met people who never took medications and the disease process was so severe that they were constantly preoccupied with voices and paranoia. They didn’t talk or interact with anyone, including their own family. Do you know what happens to those people? Look to the streets.

  • This is a good article acknowledging the profound effects stressors in childhood and in the everyday environment can influence the brain. But there are a few things here that the author is missing:

    1) High-dose neuroleptic use is listed here. Standard of care and evidence shows that you get a person with a diagnosis of Schizophrenia down to the lowest possible dosage as quickly as possible. And this is born out in studies. A recent Observational study in Sweden looking back at 21,492 people with the diagnosis of Schizophrenia and found that patients on antipsychotics, especially low doses, had a 15-40% decreased overall mortality than untreated patients. “Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patient with Schizophrenia: An Observational Study” Tiihonen et al. That is a powerful finding. The same study shows the opposite of Benzos. Don’t give moderate and high doses of Benzodiazepines to these people (or anyone).

    2) This idea of social and environmental factors weighing in on health is a double-edged sword because a lot of opponents of Psychiatry point out the WHO studies that show that people with the diagnosis of Schizophrenia in the third world do better than people in the first world (where the access to all the medications are). But what is becoming clear hear is the bigger the evolutionary-environment mismatch, the bigger the stress on the health of the person. Comparing Joe in the Amazonian jungle is completely different than Joe on the streets of New York City.

    3) Again, you would be hard-pressed to find a doctor who believes Schizophrenia is a distinct disease entity. We are probably looking at 30 or 40 different biological processes that look roughly the same on examination.

    4) His statements are really a reflection on the change in Psychiatry over the past 25 years, to a more holistic model, embracing epidemiology and trauma and wishing he had spent more time on this nexus in his career. This is not news to the scientific community.

    5) Neuroleptics can make some people worse. Absolutely. But I’m citing the study above to make the point that in by no means is the scale weighted against neuroleptics. If you get someone who cuts out his eye because he thinks the FBI has put something in it, a guy cuts off his leg because he thinks its rotting, or a teenager kills his mom because she is not who she says she is (all cases I’ve seen), and you don’t prescribe an antipsychotic? You are grossly negligent.

  • Wooha, the thread just got seriously pruned. I wanted to respond to a couple of requests that are now absent.

    Here is a good place to start:
    Efficacy and safety of ECT in depressive disorders: a systematic review and meta-analysis.
    UK Lancet, 2003.

    It is a bit old, as are some of the studies. But I think the conclusions drawn from it and the discussion are sound.

    Second, a discussion on studies and mathematics and maybe an analysis on a couple of conclusions drawn from “Anatomy of an Epidemic”. This will take some time for me to find in the book and write-up. But I will make the attempt.

    Also, forced outpatient treatment varies depending on state. So the difference in conclusions previously stated may come down to the fact that you are living in different states.

  • humanbeing, when a person comes in with catatonia, all medical conditions are ruled out — as in they are given a complete workup to make sure it is not from something else. At this point, you can wait and watch the patient deteriorate and die or you can try giving Ativan and/or ECT if an Ativan trial fails. You are talking about someone who has shut down (FMRIs have been done on these patients and their brains have literally shut down). I have seen it on multiple occasions where they are given ECT and they come out of anesthesia awake and ready to go back to living their lives.

  • You are not understanding what I am saying. The data is sound. As a matter of fact, the studies illustrated by Whitaker in the book have immense importance to the field and have helped in all kinds of ways. Whitaker’s conclusions on the data are wrong.

    What Whitaker did to his credit, is he started a conversation that needed to be had, but the book is fatally flawed in terms of the evaluating the science.

    See, what people tend to do is they regurgitate what other people have said about studies. And it makes sense. These studies are difficult to read, especially if you don’t have the background on study design and mathematics to be critical. So most of the people on this blog take Anatomy of an Epidemic on face value…that everything Whitaker says is true. Why? Because it falls in line with their world view and it is a whole lot of work to look at the actual studies.

  • The answer is it depends on the patient. If the person is otherwise healthy, then the procedure would be put off until the sleep apnea was addressed and treated. But I think if the person had a questionable history of sleep apnea and came in catatonic, refusing to eat, drink, talk, etc, then ECT would be an emergency treatment as the patient’s life would be at risk.

  • Please, show me the paper you are so eloquently citing about Pence scores?

    Hey, I ain’t selling ECT. I’m just stating it is one of the safest procedures. Giving child birth is 10 times as dangerous. If you think otherwise then show me a paper that says such. I talk in science. Show me the papers. Studies supporting your view. Otherwise you are just stating an opinion. And your opinion is uninformed until proven otherwise.

    Whitaker sold an agenda. There are so many holes in that book. I am debating whether or not to post an example. But it takes time and energy and I’m not sure any of you want to understand it anyway. Even if you are against Psychiatry and preach “Anatomy of an Epidemic,” who do you think did these studies that Whitaker cites?? These studies are science done by psychologists and psychiatrists. You are citing science done by the field because it conforms to your agenda and then calling the field a religion. Hypocrites.

  • I’m going to guess maybe “Anatomy of an Epidemic?” Don’t waste your time. I read it. It was pretty awesome how Whitaker missed pretty much every important point. I even saw Mr. Whitaker give a talk a couple of years back. He got ripped apart. I felt sorry for him. But respect to the guy for walking into the Lion’s Den.

  • Yes, I know you want this to be about you. Your journey, your pain. But you see, the thread was hijacked to attack ECT and psychiatry at large with anecdotal evidence and “expert” opinion. The only response I have to this is sarcasm. Because the real answer is anathema; that it is somewhere in the middle, and god forbid it be in such an unoffensive position. God forbid patients seek help and doctors and nurses and therapists try their best to help. And both sides are human and conversations are flawed and the best solutions are partial solutions that take two steps forward and one step back or one step forward and two steps back.

    You want the truth? The DSM-5 is based on expert opinion which is the lowest form of evidence. Psychotropics can be horrible medications with horrendous side effects. But guess what? That’s all we’ve got folks. There are tens of thousands of people working to improve it — such is the desire to help a fellow man or woman in pain. But progress is slow. Hell, look at the AIDS epidemic. How much blood and treasure went into making the current medications for AIDS. How long did it take? And that was one virus. All of these labels put forth by the DSM-5 describe a broad spectrum of diseases. Take one, Major Depressive Disorder. You know what? There are probably hundreds of different root causes for Major Depressive Disorder. The label addresses none of that. They are not there to describe the human being. That is why there is a relationship. Schizophrenia? This one is already being teased out by recent genetic map studies. There are 20-30 different gene combinations that increase risk for Schizophrenia. And this is hard math people. Schizophrenia isn’t a state of mind. Hell, it is described in every culture across the world with the same incidence rate. Is it all just being made up? Come on. Think a little. A whole branch of medicine is inching along struggling to help real people who are suffering.

    And I don’t say this in support of Psychiatry. Far from it. Be a Skeptic. Look at the papers, read the data. Be critical. This is not a thing to be taken lightly. Critical thinking is hard and takes a lot of work.

  • Umm, okay. Instead of “subset”, I will go to the thesaurus and use “a portion of.” A portion of the Mentally Ill. Seriously, your issue is with the word “subset”? This isn’t a mathematics discussion. I would hope, through the process of ratiocination, that you could apply it correctly in this situation.

    How callous of me to use a word as it was intended. Forgive me. In the future, could you perhaps provide a list of words that I can avoid using so that I don’t make humans appear less human in your mind?

    Oh, I see your final point! If they didn’t take the psychotropics, then they wouldn’t have to deal with all the things that I had listed. Those are all direct results of the drugs. What a fool I have been. It is all so easy. Person is put on psychotropics; person suffers from said list; person dies early. Got it.

  • Your language needs to be more precise.

    Your first paragraph doesn’t even make sense. If someone claims that ECT has zero side effects (which I haven’t seen anyone do BTW), that ignorant person should be willing to subject the procedure to their loved ones? How the hell does that solve anything?

    Did you know that sleep apnea is screened for when evaluating for ECT?

  • What? for fun? No. ECT is for SEVERE depression. There is a subset of the Mentally Ill that do very well with the procedure. This means you need to choose who you are going to give it to carefully. It is not a panacea.

    I am assuming (which is perhaps a bit of a dangerous proposition given the trail of comments left above) that you mean would I consider having the procedure or recommending it to a family member if severe depression were in the mix? Absolutely.

  • There is a lot of cherry-picking going on here. Read the paper in the article people. People with serious mental illness also have the following issues:

    “Higher rates of modifiable risk factors
    ƒ Smoking
    ƒ Alcohol consumption
    ƒ Poor nutrition / obesity
    ƒ Lack of exercise
    ƒ “Unsafe” sexual behavior
    ƒ IV drug use
    ƒ Residence in group care facilities and homeless shelters (Exposure to TB and other
    infectious diseases as well as less opportunity to modify individual nutritional practices)
    • Vulnerability due to higher rates of
    ƒ Homelessness
    ƒ Victimization / trauma
    ƒ Unemployment
    ƒ Poverty
    ƒ Incarceration
    ƒ Social isolation
    • Impact of symptoms associated with SMI
    ƒ Impaired reality testing
    ƒ Disorganized thought processes
    ƒ Impaired communication skills
    ƒ Impulsivity
    ƒ Paranoia
    ƒ Mood instability
    ƒ Decreased motivation”

    You don’t think any of the above has anything to do with early death?

    The worse thing you could do here is hop on the Scientology bandwagon deeeo42. ECT is one of the safest procedures and a gold standard when it comes to treating severe depression. It is all over the literature.

    “To put the mortal risk with ECT in proper perspective, it is only necessary to note that ECT is about 10 times safer than childbirth, that approximately 6 times as many deaths annually in the U.S. are caused by lightning as by ECT, that two complications of psychotropic drug therapy in younger women-fatal myocardial infarction and fatal subarachnoid hemorrhage-virtually never occur with ECT, and that the death rate reported for ECT is an order of magnitude smaller than the spontaneous death rate in the general population.”

    Take a look at another paper:
    J ECT. 2004 Dec;20(4):237-41.Paperpile
    Morbidity and mortality in the use of electroconvulsive therapy.

    Cocaine and neuroleptics work in completely different ways. Saying they are chemically similar doesn’t do anything for your argument.