Thursday, May 23, 2019

Comments by Irene Campbell-Taylor

Showing 5 of 5 comments.

  • I am puzzled by the statement:“Normally, one finds the gene and then defines the disease based on the cause.” Having been involved in the identification of the gene that causes spinocerebellar atrophy it was, like Huntington, known to be an identifiable, autosomal dominant disease long before the gene was discovered.
    All medical science depends on statistical probability. No-one is perfect in diagnosis or treatment but increased effort can lead to increased accuracy . Psychiatry seems to have forgotten the principle of differential diagnosis. It has been established several times that most of diagnosis depends on what the patient tells you that should lead to appropriate questioning and dialogue. What ever happened to the fifty-minute hour that at least allowed for the possibility of such interaction? Professor Robert Kendell was one of my instructors at the University of Edinburgh and was horrified by his own research into the time psychiatrists took to reach a diagnosis – less than ten minutes.
    To continue with causes let’s consider “Forty years on from Robins and Guze, what empirical evidence is there that disordered brain function is causally related a psychiatric diagnosis like ‘schizophrenia’?” One has to ask, what empirical evidence is there that the cause is not disordered brain function? As one of the thirty percent who hallucinate on Demerol I can assure you that I know what an hallucination is and I know the cause.
    It is repeatedly written that antipsychotics such as olanzapine increase weight. Yes, they do. But by what means? They increase appetite, that’s how. I have watched patients on olanzapine eat meals that would be too much for a lumberjack. We do know what substances control appetite, among them dopamine. We also know that most psychotropic drugs are lipophilic, heading straight for body fat where they hang around for a long time making withdrawal syndrome longer and more difficult. It is discouraging for those of us trying to improve the whole disaster of failed psychiatry and drug-soaked treatment to find an almost universal reluctance to open the mind and reject what has become a received wisdom that there is no such thing as mental illness. This dogma, just as the previous one, is going to help no-one.

  • I must take issue with the statements about the validity of psychological testing. Over many years of practice, I have seen qualified, experienced psychologists test children without first checking to see if they have had their hearing and eyesight checked; testing a child without his hearing aids in or having working batteries; aids stuffed with cerumen; without eyeglasses and on and on. Most troubling though, is the failure to determine whether or not the so-called ADD child has a history of early and severe ear infections that more often than not lead to auditory processing problems that look like inattention, cognitive impairment, even oppositional behavior along with what appears to be explosive outbursts including harm to self and others entirely due to the excruciating pain.
    Environmental,social and cultural issues are every bit as important. There is no substitute for the time-consuming, careful interview and observation of the patient, listening with respect to what he/she has to say – or quite often, doesn’t want to say and listening carefully to parents. Alas, it’s much easier to “treat” with the prescription pad, isn’t it.

  • I recently had two patients, both males aged 18 who had violent, aggressive reactions to lorazepam. One boy begged not to be given it(in another hospital, not by me) because he knew that he would become violent and end up in five point restraints. The other, also on lorazepam, prescribed by his GP, killed his mother and then tried to commit suicide. Not what one would call a sedative in these cases, I think.

  • With respect to the possible fate of the lady in Lafayette Park, I am increasingly glad to live in a country in which the forcible use of antipsychotics is not an automatic right of the health care system. The Supreme Court of Canada in Starson v. Swayze, [2003] 1 S.C.R. 722, 2003 SCC 32, allows informed refusal of medications even by a patient with a diagnosed psychiatric disorder. The presiding judge stated “Few medical procedures can be more intrusive than the forcible injection of powerful mind-altering drugs which are often accompanied by severe and sometimes irreversible adverse side effects……… a competent patient has the absolute entitlement to make decisions that any reasonable person would deem foolish”. The right knowingly to be foolish is not unimportant; the right to voluntarily assume risks is to be respected. The State has no business meddling with either. The dignity of the individual is at stake…..The Board must avoid the error of equating the presence of a mental disorder with incapacity. The patient was granted the right to refuse medications and seek psychotherapy.

  • There is an important aspect of the adverse effects of all antipsychotics that I rarely see discussed. The extrapyramidal side effects cause impairment of swallowing leading to malnutrition, dehydration, choking/asphyxia most particularly in the elderly. “Safe and effective”? I would have to disagree. For many years we’ve known that the incidence of death by asphyxia in psychiatric hospitals is 100 times that of the general population, most likely due to the use of antipsychotics. Effective for control of hallucinations etc. they may very well be but safe? Not for many. I have spent over 25 years treating individuals taking antipsychotics prescribed by others and much of my time has been spent trying to avoid death from dehydration, malnutrition and asphyxia. The TD, akathesias and related adverse events are well known but the oropharyngeal dysphagia and its consequences remains a dirty secret.