Young, Canadian and on Antipsychotics

By Neuroskeptic | December 17, 2011 10:27 am

Antipsychotic use in Canadian children and teens is rising dramatically – prescriptions more than doubled in just 4 years, from 2005 to 2009.

That’s according to a paper just out from Pringsheim et al. It’s been known for a while that broadly the same is true of the USA. The data reveal that the Canadian border is no barrier to the spread of antipsychotics.

What’s surprising is that while in the USA, some of these drugs are officially licensed for use in certain children and adolescent psychiatric disorders, in Canada all such use is off-label. That didn’t stop there being nearly 700,000 youth prescriptions for an antipsychotic in 2009, in a country with a total population of 35 million – although bear in mind that this includes multiple prescriptions for the same person.

The growth in antipsychotics is accounted for by the second-generation “atypical” antipsychotics. Risperidone (Risperdal) was the biggest success story accounting for well over half of the total.

What’s disturbing about this, as I’ve said before, is not so much the fact that these drugs are being used but the speed of the growth. It represents a fundamental shift in the way children and adolescent mental health problems are treated, one which has happened so fast that it’s hard to believe that there was time to properly think through the consequences…

Use of SSRI antidepressants and psychostimulants (mainly ADHD drug methylphenidate, Ritalin) also rose between 05 and 09, but only by about 40%. That means that there were more antipsychotic than SSRI prescriptions in children and teens by 09, which is pretty remarkable.

Only 13% of the youth antipsychotic recommendations were actually for psychosis, the original indication of the drugs. The leading diagnosis was ADHD, which is odd, because the main drugs for ADHD, such as Ritalin, boost dopamine release, while antipsychotics block dopamine’s effects via D2 receptors.


Other popular indications were mood disorders and conduct disorders. Overall, the fact that the vast majority of the antipsychotic prescriptions were not for psychosis confirms the view that the term “antipsychotic” for these drugs is misleading.

ResearchBlogging.orgPringsheim T, Lam D, and Patten SB (2011). The Pharmacoepidemiology of Antipsychotic Medications for Canadian Children and Adolescents: 2005-2009. Journal of child and adolescent psychopharmacology PMID: 22136092

  • http://petrossa.wordpress.com/ petrossa

    It seems puberty/adolescence has been declared a mental disorder.

    Good idea. Suppressing the natural development of crucial decision centers of the brain.

    That way they'll stay fixed in adolescence for life and will need meds for life.

    Money doesn't stink, just the medical practice

  • http://www.blogger.com/profile/04607118841514318206 Arid Psychiatry

    It is certainly true that the term antipsychotic does not describe the use of the agents so labelled. In child and adolescent psychiatry in the United States they are most widely used as mood stabilizers, and are especially used in aggressive states (hence their use in ADHD and conduct disorder). More and more it seems that psychopharmacologic agents are replacing psychosocial interventions, but to suggest that this is a simple process is a mistake. I am pushed to prescribe agents like these by therapists (they're not getting better), child protective services (they'll lose their placement), juvenile justice (we'll send them to prison if you don't make them stop), and parents (make them stop or send them away), and I would prefer to do a lot of other things before using them. I worry about all of the problems that these agents might cause, and sometimes end up deferring potential future problems in favor of decreasing current severe problems. An imperfect system, without doubt. If someone can propose better alternatives, a lot of us would jump at them (but make it cheap or they're not likely to get started).

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Thanks for the extremely interesting comment Arid Psychiatry.

  • Anonymous

    Interesting comment by Aric Psych. As a therapist who has worked with children for over 10 years, I've never once pushed or promoted to a Psychiatrist/or Family Doctor the use of Anti-psychotics as a 'mood stabilizer'. I have seen non mental health professionals–caseworkers, judges, and the rest push such things per Arid's comments–so that is no surprise to me. If you work with kids 'in the system' its a medication-fest. Clearly with 50%+ of all kids that go through the foster care system medicated, often with multiple medications, something is very wrong–and the use of psychotropics is pushed by schools, juvenile probation and a whole other list of folks that usually have no training in psychotherapy, medicine, psychotropics etc. Half of these idiots just regurgitate things they see on the Big Pharma ads…”Oh the kids have a chemical imbalance” too little serotonin. As if they really know such a thing. I think Arid's comment just goes to show the same thing I saw as a therapist that tried to work within that system, pressure by other actors for various reasons. Thus I go back to my comments previously on this blog–atypicals are really being used off label primarily to sedate children or “mood stabilize them”. I consider it bad science, bad therapy, and not moral in general. None of these people even know about tardive or N.M.S. etc, permanent damage done on some of these kids all just to control their behaviors (which usually still doesn't work that well anyway). Many of these kids are R.A.D. or Borderlines or abuse/sex abuse trauma sufferers and D2 receptors aren't their problem. It's unfortunate that Psychiatry has been put into the box of pills only, most people have issues in their learned behaviors, environment, support network and the like, not merely a Neurotransmitter problem. Maybe someday we will look back at this period of time where Big Pharma makes billions for off label selling of their drugs and we have thousands of kids with permanent damage–twitching and the like–things will change. But let's be clear, judges, caseworkers, schools, and parents shouldn't be directing treatment or using threats of prison–how can anyone give competent care under those circumstances?

  • Ivana Fulli MD

    Anonymous 19 December 2011 12:48

    I couldn't agree more with what you wrote but it is not peculiar to psychiatry.

    The same problem applies for example with antibiotic prescriptions demands from clients for any sore throat and as a result: an increase of deaths rate for people in need of antibiotics because overprescription makes deadly bacteria more rapidly and more often antibiotic resistant.

    Idem for people asking for “reassuring” big pharam solution for insomnia before exams, wedding, foreign travel. you name it…And also nurses who want the clients to sleep at night before a surgical intervention or whatever.

    I remember when I was a registrar in neurosurgery for 6 months many nurses asked for unwise blood transfusions to bone marrow healthy clients having just lost blood in an accident followed by neurosurgery, and not anemic enough for me to prescribe blood transfusion. It was difficult to convince the good nurses that no professional soccer match was scheduled in the next 3 weeks or so for the clients and that I was not worried at all and intended that nobody will make my clients worry about anemia because god gave them all the equipement to recover a healthy pink inside the lower lid soon enough before discharge from the hospital.

    NB: I had to bake cakes on my spare time to remain on friendly terms with very nice nurses because I always was the resident who do not like to help clients and reassure nurses with a lot of prescription and transfusion -and I would not want the nurses take-unconsciously of course- a little more time than safe to wake me up if something happens to my clients…

    That is one of the problem isn't it?
    For th e psychiatrists it takes time and cakes not to prescribe.

    Lucky you Arid psychiatrist!

    Of course I agree to what you say: we -psychiatrists- are an easy target for simplistic hypocrite attacks on the ground of over prescription of drugs that staff and family beg us or threatened us for.

    Those hypocrites are making the scientologist work easier. -still some of us -in America notably- are black sheep aren't they? I am thinking of those who want only to prescribe drugs as quickly as possible to make more money. And any talking to to be done with a psychologist. And those academics on Big Pharma payroll.

    Lucky you, because in France psychiatrists have to suffer also from a very strong psychoanalytic political lobby-if like poor I you were trained in up to date countries and do not buy that psychoanalytic silly enoiugh religion, a profesional psychiatrist life can be difficult and you are accused on being on Big Pharma payroll.

    Anywhere from hospitals to diner tables and market places or comments on blogs: in France, anybody is competent in psychiatry but the MD and psychiatry specialists on the social front.

    In France in addition to the psychoanalyst strong lobby and the scinetologist like anti psychiatry, we have the right wing demagogic ideology who denigrate psychiatrists (mad themselves or useless at least ) and promise the voters tough laws in order to protect society against the mentally ill.

    That ideology make us psychiatrists and the mentally ill dangers to society when- as Pr Dave Nutt put it alcohol intoxication in a husband or car driver and horse riding kill more often innocent people than a mentally ill person.

    On the bright side, Med School is almost free in France.

  • Anonymous

    Well Dr. P Nutt lost his job for that remark, the so called Nutt Sack incident

    As has been alluded to, there is something wrong not just with systems but society in general when is unacceptable to slap a child (I agree of course) but it is OK to give them as many antipsychotics as a Dr. is willing to prescribe. Which causes the most harm in the long run. Both I suppose if overused but if it was a case of a lot of antipsychotics or a little slap now and then I might change my mind about the unacceptability of the odd slap given to a rambunctious child.

  • Ivana Fulli MD

    Anonymous19 December 2011 20:00

    “Well Dr. P Nutt lost his job for that remark, the so called Nutt Sack incident”

    Pr David Nutt lost only a political appointment as a health minister adviser.

    For writing that alcohol and horse riding are more harmful than cannabis in a report.

    He gain a lot of admiration for it and can still enjoy a living.

    So what was your point?

    I for one -strongly dislike the activist of any sort who are afraid to make the politicians unhappy.

    We have in France a lot of activists who pretend that they have to be diplomatic and friendly with the politicians.

    Be it only because the successful politicians will always beat you at that game.

    It is their trade to promise a lot and give little since their ressources are scarser than the demands put on them by lobbyists and activists.

    That is if your aim was not fame and important political friends in the first place.

  • Anonymous

    @Ivana

    Apologies, just like making the nutt sack joke really.

    My point though was rather like Proff Nutt's in that I was making a comparison. Slaping bad / antipsychotics good. Both infact serve the same purpose.

    Antipsychotics just enable little Johnny to sit still long enough to learn how to control himself, the slap does the same thing just more directly. The Dr's dilemma is that one is socially unacceptable and the other is not.

    You tell me which is worse in the long run.

    I agree about activism. To have influence of any sort one has to sell a bit of something. For politicians and activists it is a bit of their soul. The alternative is to be a saintly irrelevance.

  • Liam Tjia

    I'd like to add the perspective of an Australian paediatrician.

    I strongly agree with most comments and add that at least in Australia most children with a diagnosis of ADHD and autism are primarily cared for by a consultant paediatrician. These are not primary care doctors, they are specialists who have completed a long training path, equivalent to board-certification I believe. However most paediatricians do NOT have the expertise and training of a child psychiatrist and in my opinion most do an inadequate job with these kids and many do an appalling job, including too easily buckling to pressures to prescribe dangerous medications where a psychiatrist would be more prudent. This is the anomaly of a system where specialist paediatricians greatly outnumber child psychiatrists so are easier to access. Paediatric training, under monopoly control of the national Royal College, is shabbily run so that despite posturing about the importance of serving these kids well, there is no requirement for any period of training in ambulatory child psychiatry under the supervision of a psychiatrist, surely the best way to learn appropriate prescribing. Other areas of critical importance to practice such as neonatal resuscitation do have mandatory periods of training attached (other models of accrediting training, alternative to marking time spent in particular jobs is a separate issue).

    So I'm sure Australian rates of prescribing Risperidone in particular have also exploded and that paediatricians rather than child psychiatrists would be responsible for most of the increase, all of which is a serious worry. North American and European systems are all a bit different to ours but I bet this is also partly true in many of those areas.

  • http://www.blogger.com/profile/01866791882715154854 LeoB

    Do you know anything about how much antipsychotics those young people get, especially those 87% that do not have any psychosis? (I assume you know D Lewis comment in the beginning of the year on such uses of antipsychotics?)

  • Ivana Fulli MD

    Anonymous 19 December 2011 21:33

    Dave Nutt is anything but a saintly irrelevance.

    He is a professor of pharmacology with a very potent voice both in his professional field and in the public at large.

    He is not saintly at all!

    I am not at all agreing with him and I think the man dangerous in sort of promoting cannabis as safe.
    I would like parents and children to know that cannabis is an experience at least to postpone to adulthood ( studies and long experience of Indian and Maroccan psychiatrists make one fear a psychosis increase risk
    for young people with a phenotype we are not able to tell now.)

    I also think that smoking tabacco is the most addictive bad habit a teenager can take and it kills and make premature babies surviving bad quality placenta for nutrition in the womb…

    You wrote:
    “To have influence of any sort one has to sell a bit of something. For politicians and activists it is a bit of their soul. The alternative is to be a saintly irrelevance.”

    Plus Activists made the Arab spring Anonymous19 December 2011 21:33!

    (Sorry about that bout out of topic neuroskeptic but make amend to my poor nerves I am just a middle-age clinician trying to work in France)

    Plus,
    The many British activists in mental health are doing an incredibly great job from big and small organization

    and have made their governement go back on important points recently.

    It is just that a coward activist -to my mind- is just as good as a coward soldier: very dangerous for other people with some advantages for the coward who makes other die because he took a coward covert when he was ordered to help other.

    same for activist who want only their fame and lunches with politicians and travels-You name it.

    May be in corrupted regimes like Southern European France and Italy (until recently )or Greece the people get the activists their politicians desserve.

  • Ivana Fulli MD

    Anonymous Anonymous 19 December 2011 21:33

    Slapping and physical harm of children and vulnerable adults (metally ill and elderly people)is just unacceptable as a treatment policy by physicians and staff.

    Beware that it is not an alternative:

    where vulnerable people (elderly or mentally ill or autistic persons) are the victims of physical violence in institutions

    they also suffer antipsychotics and other Big Pharma medications if it is in a rich country and not in Kenya to give an example.

  • Ivana Fulli MD

    dear Liam,

    Thank you so much for your comment on your experience.

    I am hoping for the French psychiatrists to receive continuous education in pharmacology and medecine as much as you want the Australian paediatricians trained in child psychiatry!

    Indded

    -and I am not making this up-

    what worries me is that in France the child psychiatrists are very very often only psychoanalysts at heart and many adult psychiatrists also.

    With the full approval of the medical boards and most of the French talking classes.

    I was not able to work in a psychiatric non academic hospital -in order to work part time to raise my children when I gave up the idea of becoming an academic pharmacologist or a researcher at least- because those people were prescribing very potent drugs with a very light mindset.

    Many psychiatrists in France are interested only in discussing and publishing in psychoanalysis and are separated in different sects and absolutly isolated from the world psychiatric knowledge.

    And they still receive gifts from Big Pharma visitors

    and received them absolutly unprepared.

    and the last passion of theirs is

    “neurospychoanalysis”

    a sort of religious rite where they try to make neurosciences formidable advances (see neuroskeptic I can be diplomatic )compatible with their understanding of the Freud religion.

    Neuroskeptic made a post on that new religion the
    “neurospsychoanalysis.”
    in oct 2011

    -only the title was badly chosen to my mind and its poor command of English: “pack it in”

    NB: I admired and learned occasionnaly from listening and talking with clever and interesting psychoanalysts in meetings but those happen to have always been working in USA, Canada, Italy, or at the Mausdley hospital in London.

    Thank you neuroskeptic for a very interesting learning opportunity by discussion with clinicians.

    And please do more posts about “neurospsychoanalysis”.

    That religion has meetings all over the world. They had one in Boston last summer if I can trust a psychoanalyst and psychiatrist friend of mine.

    I would dearly like to know if some non-French are doing interesting “neurospsychoanalysis or if they are Pierre Delion French intelectual caliber as a specie.

  • Ivana Fulli MD

    Sorry Dearest Roger,

    I am just proving what I just wrote:

    Pierre-Antoine | 20 décembre 2011 à 00:16

    in

    http://www.philippebilger.com/blog/2011/12/je-viens-de-terminer-une-biographie-de-primo-levi-et-japprends-la-mort-de-vaclav-havel-lobsession-du-premier-%C3%A0-la-fin-de-s.html#comments

    Justice au singulier is a blog by a former criminal Appeal court “accusatory” Judge and media darling's blog ( a french baroness Greenfield of sort but for law):

    “Justice au Singulier”

    Pierre-Antoine | 20 décembre 2011 à 00:16 goes like that:

    (…) With the new DSM IV (sic for the IV not my typos ), we shall not have any questions to ask ourselves, we shall be all, at best des “exilés de l'intime”

    title of a book from José and Delvogo about overmedicalization of sane people,

    at worst nevrotics with a delusional-perverse side or psychotics with a mystic delirium ( if not the other way round)

    And of course our dear (very expensive ) psy will reorganize our neurons using new molecules.

    Hourra for the tandem pharmaco/psy… There is big bucks to be made.

    PS: Thanks for the link to the Figaro who left me speechless on the professional abilities of your colleagues.(…) “

    This beacause I had dare to question his other darling

    - after the scientologist like antipsychiatry movement -

    a right wing activists asking for maximum penaltiesand time served in regular jail and not forensic hospital for delusional criminals.

    2) I do not want to venture about out of topic discussion but an article exposed French forensic psychiatrists not at their best.

    http://www.lefigaro.fr/actualite-france/2011/12/12/01016-20111212ARTFIG00498-les-experts-defilent-au-proces-valentin.php

  • http://www.blogger.com/profile/17401232760394588049 John

    And so we shall wait for the law suits to follow because there is some data out there suggesting certain antipsychotics can induce cerebral atrophy, type 2 diabetes, obesity, heart failure. The issue was first raised by none other than Nancy Andreasen and recent research offers further support. Irrespective of how that line of research pans out, surely we must be insane to ignore the neurodevelopmental impacts of such powerful drugs. They scream about the dangers of marijuana but but the profile of some antipsychotic drugs is much worse. It isn't just the young you are being increasingly medicated with these drugs, those in aged care facilities continue to be prescribed these drugs in spite of studies indicating no benefit. Of course not, but you've sedated the elderly patient, at that age being at much higher risk for type 2 diabetes, heart failure … . You haven't helped them, you've just stopped them being a problem to you. We're doing it to the young and old, it is almost like an incipient and pernicious social darwinism against the troublesome.

  • http://www.blogger.com/profile/01866791882715154854 LeoB

    @John: Aren't we talking about diabetes 1 (or 1.5 as it was renamed to later when not present at birth)?

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    John: On that note another paper recently reviewed antipsychotic side effects in children. Risperidone, the most popular drug in Canadian kids, was found to be the second most weight-gain-ish (second to olanzapine).

  • Ivana Fulli MD

    Dear John,

    Was it not Nancy Andreasen who prematurely boasted to the world just the opposite of her last findings?

    Admitting that she was not boasting about her previous conclusions, Big Pharma propaganda made the most of it.

    I protested alone with a young woman not even yet qualified when the amphiteater was packed with French speaking academics in Nice 2009 when

    to sell Zyprexa depot at the first treatment as soon as possible and for life after a single psychotic episode

    one French academic in a panel of several( who did not contradict her )

    told an audience of psychoanalyst precribers of drugs (we were in a French speaking meeting) that it was our moral responsability not to let psychosis shrink their brains!

    And that the scientific literature had demonstrated it.

    An academic from Marocco also told that haloperidol still worked better for some patients.

    NB:I remember that when I was a young research registrar in Oxford I told a slightly older researcher that I had a good idea in France but I would never try to publish a clinical trial on it because I will not get the support needed to have enough subjects in my groups and would not take the risk to conclude in the wrong direction.

    I was answered:

    “Publish it and then retract and you get two papers.”

  • http://www.zyprexa-victims.com Daniel Haszard

    Be aware of drugs that potentiate diabetes.
    Eli Lilly Zyprexa Olanzapine issues linger.
    The use of powerful antipsychotic drugs has increased in children as young as three years old. Weight gain, increases in triglyceride levels and associated risks for diabetes and cardiovascular disease. The average weight gain (adults) over the 12 week study period was the highest for Zyprexa—17 pounds. You’d be hard pressed to gain that kind of weight sport-eating your way through the holidays.One in 145 adults died in clinical trials of those taking the antipsychotic drug Zyprexa.
    This was Lilly's #1 product $5 billion per year sales,moreover Lilly also make billions more on drugs that treat diabetes.
    — Daniel Haszard Zyprexa activist and patient.

  • ivana Fulli MD

    Dearest john,
    You wrote:

    “They scream about the dangers of marijuana but but the profile of some antipsychotic drugs is much worse.”

    Since we can reasonably admit now that cannabis is a serious candidate for an increase risk of schizophrenia or at least making the onset sooner in phenotically vulnerable people

    And since those young people get antipsychotic drugs as soon as they present a psychotic episode close enough to a psychiatrist

    I do not feel uneasy about asking teen-agers to post-pone that experience until adulthood ,and I think a few beers are less of a danger unless we know that there is a risk in the family for alcohol addiction-genetic studies on that alcohol addiction front genetic predisposition.

    if the scinetis involved are not boasting prematurely that is.

    NB: one solution would be for clinicians to stop considering any published paper in a good journal as valid as the Coran for a faithful muslim.

    Would it not follow logically that psychiatrists hawhen imbibiting a teen-age brain

  • Anonymous

    Some of these comments, are why I've stated before that too often the atypicals were basically being used to sedate children/people. Why not just give them ambien, no behavior problems with unconscious kids eh?

    I see kids being taken from parents for being “too obese”. Yet, I've seen caseworkers and others advocate for more drugs to get children to “stabilize” despite huge weight gains. I had one girl who went from 80lbs to 150 lbs in 5 months, on good old Atypical…she was lethargic, depressed, bloated and had severe body image issues after nearly doubling in size. I was concerned, but apparently Psychiatrist didn't seem it was a big deal, of course trying to treat Reactive Attachment with atypicals–massive doses in her case, merely to 'control her behavior' was sadly far too common with poor kids who have no voice. And of course us non-psychiatrists can't advocate much for them, and some of the children's advocates are just shills for the caseworkers/counties. Drugs have their place, but the massive amount of off label scripts for atypicals I saw this past decade has been immense. Of course “resistant depression” become the next incarnation for selling this stuff. So giving children type II diabetes and morbid obesity is OK, as long as some people get rich doing it, and they are sleepy enough to justify that it helped “mood stabilize them”??!?!

  • ivana Fulli MD

    Sorry dearest john for my last sentence,

    I had intended to write:

    Would it not follow logically that North American psychiatrists -paying good money for their insurance coverage – having iibibited a teen-aged or even child brain with antipsychotics unecessary and making their brain shrink or an adult and making him diabetic

    should make law suits against the Big Pharma propaganda with the help of their professional assurance coverage?

    Instead of letting the clients like Daniel Hazsard alone to fight Big Pharma or the psychiatrists.

    Of course, Daniel Carlat the bloger and author of the book “Unhinged” or somebody of his moral stature should preside the committee making the selection of the psychiatrists

    in that collective law suit asking compensation from Big Pharma hand in hand with the clients.

    We do not want those black sheep in Big Pharma payroll like some harvard academics do we?

  • http://www.blogger.com/profile/01866791882715154854 LeoB

    @Ivana: Could you please tell a bit more about Andreasen? What was she saying now and what was she saying before?

  • Ivana Fulli MD

    Anonymous 21 December 2011 12:04

    Psychiatrists are sometimes greedy-

    specially in America because their often hudge Med School debts seem a sufficient reason to want also a luxury lifestyle and a luxury retirement life style.
    See:

    Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy – NYTimes.com
    http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=1&ref=health

    The only time I went to an American Psychiatric Association annual meeting almost everybody asked me how much money French psychiatrists were making and they were disgusted by the answer.

    Big pharma marketers are criminals that destry lives and kill clinets prematurely and so are some of the psychiatrists on pay roll and some of the pharmacologists on pay roll.

    According to a French newspaper Pr Jean-Michel Alexandre – former director of the French agency evaluating the drugs -had received almost 1,2 million Euros from SERVIER laboratory between 2001 and 2009.

    http://sante.lefigaro.fr/actualite/2011/12/19/16526-grande-generosite-servier-envers-expert

    Who need that amount of money to live decently in addition to an academic salary?

    In the big servier scandal about Benfluorex MEDIATOR French professors of pharmacology told the IGAS Inspectors (IGAS is the French bureaucratic health control office) that they didn't know about benfluorex being an anorexigen: « -orex » means just anorexigen 2 for the OMS (product SE780 from Servier was denominated benfluorex by the OMS volume 25, n°3 March 1971.

    http://www.igas.gouv.fr/IMG/pdf/Synthese_MEDIATOR.pdf

    Those academic experts that told the IGAS inspectors that Servier had mislead them “rouler dans la farine” should lose their medical board accreditation and academic position!

    Still,it remains that western societies at large had been delusional about the progresses of psychiatry because of psychoanalysts who were crooks (Bruno Bettelheim who claimed to cure autism)

    and after that biological psychiatrists gave the world an illusion about chemical cures of psychiatric deseases

    I am not Einstein caliber and I knew since 1997 that my dreams and expectations in biological psychiatry had let down the patients.

  • Anonymous

    I have seen some good from Psychotropics, although in my experience they are rarely 'curative' they have helped many of my clients to reduce pain/suffering. So despite my many frustrations with the forced drug treatment of foster children, or children in general–particularly when the medications cause more harm biologically or psychologically then whatever if any good they supposedly do–as I have seen often with Atypicals neuroleptics for off label use.

    Whatever happened to “Primum Non Nocere”, I as a non-medical doctor keep this in mind, since even talk therapy has the potential to do harm to some degree–particularly poorly timed paradoxical techniques for example. But liver damage, brain developmental damage, obesity, diabetes, tardive, and all these very real potentially permanent side effects need to be considered seriously against any benefits of such drugs. My personal experience is that they clearly are not. Kids in group homes are jacked up on atypicals to remediate behaviors via the mechanism of fatigue–when it boils down to it. Almost none of these kids are psychotic, or bipolar etc etc. Fifteen minute med checks to amp up the dosage to help some kid on massive amounts of amphetamines–sleep, or to reduce aggressive behavior chemically continues to be the norm for those that don't have parents advocating for them. Thus 50%+ of children in foster care are medicated, often medicated with many drugs, one per symptom. Psychiatry has a long history of severe abuses of clients, even with good intentions–causing permanent damage to those who don't have the power to refuse 'treatment' is amoral/unethical in my opionion. But it remains the economic imperative of many Psych's, and they do often get pressure from the CJ system etc. But let's be clear, Probation officers don't coerce heart surgeons to perform uneccessary heart surgery on people with no cardiac problems, so Psychiatry should not give in either–its called professional courage!

  • Ivana Fulli MD

    LeoB

    Until very recently misusing Andreassen previous studies Big Pharma paying academic psychiatrists at least in France (I heard it in Nice dec 2009 and in Paris spring2010) told psychiatrists that:

    without antipsychotics for life the brain of the schizophrenic persons will deteriorate and shrink

    then it was a moral duty to make antipsychotics (and Zyprexa in particular in Nice)treatment mandatory for schizophrenic persons.

    NB: French psychiatrists are not strong on “Recovery” and are very paternalistic and very backward in social psychiatry; so that propaganda seemed to me more frank in France but only marginally so.

    This Big pharma propaganda was just ignoring the big OMS study showing that long term schizophrenic did better in the third world countries were they had less Big Pharma drugs ( Norman Sartoriius OMS studies papers)

    and even longitudinal studies like for example:

    The Journal of Nervous and Mental Disease • Volume 195, Number 5, May 2007
    Martin Harrow, PhD, and Thomas H. Jobe, MDA
    15-Year Multifollow-Up Study:

    “The current longitudinal data suggest not all
    schizophrenia patients need to use antipsychotic medications continuously
    throughout their lives.”

    This in a editorial for a study by
    Beng-Choon Ho, MD,
    MRCPsych from the University of Iowa Carver College of Medicine

    In Arch Gen Psych. 2011;165:126-137.
    patients with schizophrenia receiving antipsychotic medication may lose a small,but measurable, amount of brain tissue over time.

    Patients who take the largest doses over the longest duration of time are apt to see the greatest declines.

    Illness duration and severity were also associated with brain volume loss, but the association between antipsychotic druguse and brain volume remained significant after accounting for these factors. The volume losses occurred in gray matter and white matter.

    Note that as soon as the MRI spoke against Big Pharma propaganda

    -but beware that temporal correlation is not equal to causation-

    David A. Lewis, MD, from the University of Pittsburgh wrote in an editorial associated to Dr Ho paper that:

    “A classic maxim in clinical medicine is to treat the patient, not the laboratory test — or in this case, the MRI,”

    (sorry neuroskeptic and chums but LeoB asked me)

  • Ivana Fulli MD

    Anonymous21 December 2011 14:17

    It would be interesting if you could tell us in which country you work.

    But for professional courage of the psychiatrist individual prescriber (Arid Psychaitrist ) you need at least:

    academics in your field not telling and taking as good practice what you disapprove with the medical board acting often like medical gestapo as soon as you are a dissident.

    Plus for France -unlike common laws countries -we have a law that punish harshly anybody for not giving help for a person in danger unless giving a hand would make you endangered your own life.

    It makes prescribing safer than non precribing when academics tell the world that you should prescribe.

    Some texbooks and insurance people tell you just that : in doubt prescribe something (and homeopathy won't do)

    because the kind of criminal offense is different and much more benign if you prescribe and give side effects and not improvement than if you do nothing in case somebody is hurt.

    Sometimes a psychiatrist takes great risks in opposing a parent or a staff non MD asking for sedation by drugs-especially if they do it in writing like in the nurse observatory notes or a letter from the parents.

    And the medical gestapo might consider you dangerous if you prefer homeopathy or wheighted blankets to please parents and make an autistic teenager sleep a little better.

  • Anonymous

    I'm in the US. I can see why many would feel pressure to prescribe, rather than not prescribe. Many of the cases I was referring to were not patients who were suicidal in any way or form. Many were already medicated with other drugs beyond Atypicals. They easily could have not added the atypical to the mix of psychotropics they already gave to the children. No child is going to learn to control impulses by merely being sedated. Many of the children I was thinking of–did not have any extreme behaviors. Were they mouthy, oppositional and on occasion defiant–sure, but not attacking others or the like. I still see Atypicals for non-behavioral problem kids as well, basically to help them come down from a high dosage day of Methyl/amphetamines which cause insomnia problems with some of them. Sleep problems sometimes are such a huge issue, its hard to imagine any person having a good ability to pay attention if they have chronic fatigue.

    Not one case I was thinking of was the kid on merely one drug, they could have dropped the atypicals, and most still would have been on 1-2 drugs at least. Learned behavior is certainly still a big issue in psychology. Atypicals are my soapbox issue, since I've never seen anything like it before–at least ADHD meds/and Anti-depressants were/are attempting to modulate/remediate a clear symptom cluster. Hell, fatigue or sleep is a potential remedy for nearly everything then eh? If someone is depressed, they probably will depress a lot less if you jack them up on seroquel and they pass out. Hard to actively depress or be anxious or anything else for that matter when your not conscious.

  • Ivana Fulli MD

    Thanks for answering.

    I agree with you more than you might think even if I am an adult psychiatrist with no experience at all of treating children.

    I had to homeschool my onwn very gifted children because they were bored and bullied at school and for some years 1997/2001 I did some informal pro bono for a parent of gifted children's association.

    My eldest son was very agitated in class in his second year of elementary school until I obtained for him to jump a class after spring break and he became in two weeks the darling of the new elementary teacher.

    I have the class reports to prove itand nowadays even in France the school might have suggested ritalin or the like and it was difficult to convince them that he was bored -actually a few year later they refuse to let him jump another class and I had to homeschooled him.

    I met an Israeli academic child psychologist later who told me it was a classic the pseudo attention deficit disorder of very bored gifted pupils.

    I can tell from more than my experince with my own sons that a child can be bored into misbehaving at school and jumping class can often solve the problem, not medication;

    and that on the contrary a teenager who cannot read properly has every right to be agitated in class since he cannot do properly not even any math exercise because even for math a teenager needs to understand the writen text of the exercise and text book. Semm obvious. Not in France.

    I had one family who following taking off from school a very bright son who was an underachiever and dyslexic but with a very high IQ,he abused verbaly the teachers and throw tandrums at school. The child psychiatrist in charge since years told the parents that he was cured soon after the boy was not going to school anymore (he was homeschooled with little academlic rsults but open a little cafeteria and then a restaurant and last time I heard news he was employing his very successful academically sisiter to do the accounting).

    Also adults clients have been talking about their school days: one had been bullied for months in the playground at school and at some point he lose his temper in the classroom and not in the playground at some minor thing: he had medication and expulsion from the school.

    I have yet to meet an aspie who tell me he enjoyed school because they have been bullied in the playground and lost in the classroom because autistic pupils need to be told not once or twice but very regularly and very precisely what is going on in the classroom and what they are supposed to do in details even with very high intelligence.

    Very often they had get medication instead for agitating or violent behavior as teenagers.

    and my adult clients are blessed because the younger aspies are getting “atipical” as you wrote nowadays

    When I visited an aspie association some years ago I saw a mothers who begged me for help in getting a son off antipsychotics and I could see that the boy was almost larger than tall.

    I could do nothing because a professor of child psychiatry had prescribed it.

    We shall not forget that for some parents who beg or threten because they want antipsychotic prescription for their son you get parent who suffer from the prescription and have difficulties with the doctors and staff.

    Of course, real medical life is complicated and sometimes the parents complain but they want an institution to deal with their child.

  • http://petrossa.wordpress.com/ petrossa

    “Since we can reasonably admit now that cannabis is a serious candidate for an increase risk of schizophrenia or at least making the onset sooner in phenotically vulnerable people”

    You have that backwards. In the netehrlands where cannabis is freely used since decades Schizophrenia isn't more prevalent then elsewhere. And that is even whilst the THC content there is very high indeed.

    Schizophrenics are just more likely to selfmedicate hence they show up more in the drugculture.

    What you wrote is just a sample of confirmation bias.

  • Paul

    Petrossa,

    Does the availability of cannabis in Holland equate to more people using cannabis, than say the rest of Western Europe?

  • http://www.blogger.com/profile/17401232760394588049 John

    Ivana,

    The use of antipsychotics for schizophrenia and psychosis are not in dispute: costs and benefits basically. But the use of these drugs in so many children who are not psychotic, and the elderly for that matter, is an issue that has gotten way out of control.

  • Ivana Fulli MD

    petrossa,

    We are not talking about the same issue.

    1) To the best of my knowledge there is a sufficient body of evidence in the medical litterature- plus what the Indians and Maroccan psychiatrists have tried to tell the OMS for decades in vain-

    to tell children and teen-agers to post-pone smoking cannabis until adulthood -I guess 22 years old- because to abstain might prevent some subjects to become psychotic or at least post-pone the first psychotic episode.

    I think that Pr David Nutt might be a bit of a demagogue but I agree that for society at large alcohol consumption is more dangerous

    It is just that I found the social stigma and the suffering of the psychotic persons something not worth the risk.

    The suffering seems to me even worse than the terrible anxious state many aspies feel when their life has some unexpected events in it like a transport strike or whatever.

    2) What you are writing is a beneficial effect for person with schizophrenia.

    Counter-intuitive but medecine often is and I am not a paternalit psychiatrist nor a science ayatollah.

    NB : And as a pharmacologist by training I know for sure that chain smoking tobacco had for my psychotics clients during my hospital days a therapeutic effect at a very high cost for their health:

    They tobacco smoked themselves into reducing their blood level of antipsychotics then reducing their side-effects from the drug.

    One of the reason I cannot wwork in France in a psychiatric hospital is that many psychonanlyst psychiatrists would not accept that I would trade with clients a lowering of the antipsychotic in exhange for a decrease in their smoking.

  • Ivana Fulli MD

    Paul,

    You wrote 22 December 2011 02:26

    “The use of antipsychotics for schizophrenia and psychosis are not in dispute: costs and benefits basically.(…)”

    Although I agree 100 % with what you wrote after that I cannot agree with your forst sentence because studies are showing just the opposite MIGHT be true

    (a first psychotic episode might resolve better on the long term without antipsychotics treatment and at least on the long term “schizophrenics” seem to do better without treatment.

    of course the group are selected with imperfect criteria since the battle still rage between neo-kraepelians and many other concepts of what is schizophrenia.

    You wrote also:

    “But the use of these drugs in so many children who are not psychotic, and the elderly for that matter, is an issue that has gotten way out of control.”

    I couldn't agree more with you but -whatever your political agenda is- I see no reason to confort Big Pharma in making big bucks on another vumnerable population the so called schizophrenics selling for them in first treatment very dangerous products and for life and in a depot form.

    NB:John,

    I did some pro bono with elederly and of course a feww weeks on “atipical” might give diabetis but

    antipsychotics kill elderly person by making them lost balance even more than age and broke their neck of femur.to break your neck of femur shorten life and worsen the quality of life.

  • ivana Fulli MD

    petrossa,

    I was not pulling your leg writing about the terrible anxious state aspies can find themselves in with a transport strike.

    We have one in France right now at airports (from the luggagges and clothes security control people).

    I listened to very anxious aspies may be as intelligent as you are who cannot cope easily with a strike who interfere with their -already painfully made – Christmas travel plans to go and visit family.

    I know every aspie is different and some manage to escape public transport and do noit travel much.

    Some might be philosophical with changes in transport plans and you might be one of those.

    I wish you would comment more often neuroskeptic posts and wrote more post on your blog.

  • ivana Fulli MD

    neuroskeptic

    I wish you a merry Christmas and every successes in your research, and personal life for 2012.
    I am not alone in wishing you keep posting a lot in 2012.

    I also wish that you will be less narrow-minded and a little more modest than Dr Ben Goldacre-

    and that will not go for the throat of physicians trying to find alternative ways to Big Pharma drugs for helping clients not in need of Big Pharma drugs -or more precisely clients when not in need of Big Pharma drugs.

    Using homeopathy as a tool to relieve suffering -and using it only not to precribe big Pharma drugs in various cases from stage fright in an amateur or professional musician to viral or even bacterial but non strepto proliferating sore throats should not be considered a crime against enlightment and science in itself.

    (MD have an easy way to exclude the strepto cases who need antibiotics to prevent possible heart valvula damages with a cheap laboratory test-cheaper than antibiotic resistance on the human cost)

    I do know that -unlike Dr Ben Goldacre – you have not in your professional ethical code to relieve suffering.But Science without conscience is a ruin of the soul said a XVI century physician and writer (Rabelais)

    and you should be careful when you help activist demonize a brave heart like Pr Pierre Delion for using packing when so many other child psychiatrists and psychoanalysts in France will be happy making children dumbs with legal drugs and not respect the parents and clinical contreolled trials as much as Pr Delion does-to the best of my knowledge.

    Pr Delion is speaking right now very vocally and strongly against Pdt Sarkosy unacceptable policy in pedopsychiatry :
    the school administration have now the power and duty to select 3 years old as potential dangers to society and keep files on them without involving the parents!

    Pr Delion protests with good senses and ethics and asked for the schools to tell the parents their child is trouble and let the parents deal with finding a professional help.

    He is against the school keeping files from 3 years old supposed jail materials.

    And beware NS that I am not out of topic because packing is an alternative to stronger and stronger regimen of antipsychotics in autistic children who self-arm.

    I find that more dangerous than packing

    since it might interfere with the autisitc child ability to learn how to communicater better, then self-arming less because often they self-arm when overwhelmed with sensory stimulation or when suffering pain (ulcer yes but also abdominal pain without a clear physical culprit)

    I am more for weighted blankets or clothes to apply soothing deep pressure than packing

    and I admire Autism research for promoting clinical studies of weighted blankets

    I do not admire at all a British academic and sleep specialist -I found the most inbtelligent and charming man as a person and a scientist – for speaking in St Andrews Northampton 2011 conference on asperger about sleep problems in autism and just ignoring the weighted blanket potential benefits when a work out I benefit from at the same meeting was made by ST Andrew occupational therapists who demontrated with 300 pounds funny blankets…

    I think that Pr Deliuon should not be freely presented in your blog as an insane corpses and death maniac or a nazi sort of doctor taking for fun the risk of killing children with hypothermia.

    NB: Some antipsychotics kill people by interfering with thermic regulation when the weather is hot like in France summer 2003- my estranged husband was an intensive care professors and I know that from emergency doctors ' diner talks.

    Packing will not kill children by hypothermia the way Pr delion practice it.

    Sorry about my poor command of English and lack of time to reread what I wrote before you publish it.

  • Ivana Fulli MD

    Also petrossa 17 December 2011 11:04,

    I wish you happy holidays and hope you might realize that :

    Taking advantages of selfconscious and social image insecure and sexual orientation insecure, school badly taught etc(..you name it) teenagers

    to make money selling under age persons alcohol, tobacco or street drugs

    do stinks at least as much as Big Pharma marketing propaganda to expande selling of their drugs product.

    You wrote 17 December 2011 11:04
    “Good idea. Suppressing the natural development of crucial decision centers of the brain.

    That way they'll stay fixed in adolescence for life and will need meds for life.

    Money doesn't stink, just the medical practice”

    Do you not realize, petrossa,with your years of studying the medical litterature that a teenager who starts smoking tobacco to look glamorous at parties – and have something to do with his(her )hands -will be hooked for life often enough.

    -I know nothing more psychologically strongly and rapidly addictive than tobacco but it is just an example.

    And simplistic political agenda stinks.

    For another example, I attended conferences by an American health economist academic in sabbatical in Paris -a pupil of Aaron Wildavsky-

    Pr Joseph White , who told an audience of pharmacologists and health economists and French public servants in 2011 what were Pdt Obama reforms and at larger explained a little the American Health system.

    Not looking for it-and as a side topic- I learned that according to PR White knowledge of the scinetific litterature of his field-

    that alcohol prohibition did make global health better in America on the alcohol complications front but it increased crime.

    it was unbfortunate for me to learn that because it will complicate my life if I report that to cannabis free trade political activists.

    I am not a paternalist person but I know I will be under attacks just for reporting that fact Pr Joseph White presented as scintific current knowledge.

    Sadly enough,

    in natural sciences and medecine

    reality always strickes back with its complexity.

    NB: when Tom cruise, the American actor lobby for scientology I always remember that it might be true that the scientologists have saved the younger adolescent Tom Cruise from dyslexia and lack of self-confidence.

    It doesn't make me suffer gladly scientologists activists or silly antipsychiatrists as a specie.

    - you do not look at all like a scientologist to me (of course I may be wrong) and you are anything but stupid (on that point I am confident).

    NB2-some pervert gangsters in the drug cartel might also have a more personal agenda and for example might like the killing part of the business of course.

    happy holidays petrossa.

  • Roger Bigod

    Ivana Fulli,

    “to abstain might prevent some subjects to become psychotic or at least post-pone the first psychotic episode.”

    As I pointed out, this conjectural good may be outweighed by the misallocations of resources, jail sentences and criminal records, corruption of the legal system, turning Mexico into a failed state, the taboo on honest research on cannabis and psychodelic drugs. But you keep repeating the same point. Since the owner of the blog apparently agrees with you, I will defer to his judgment and take this site off my list of places to visit.

  • Ivana Fulli MD

    Dearest Roger,

    I suggest you do as I did and continue to read the wonderful NS post when abstaining to comment.

    I imagine that it is as easy as to stop tobacco smoking:

    Who said that he could testify about how easy to quit smoking cigarettes since he repeatedly stopped smoking?

    Not dearest Roger for sure because that one as a sense of humor.

    PS: Jane Austen would have said that NS doesn't desserve that praise nor that critic.

  • http://petrossa.wordpress.com/ petrossa

    Ivana evidently you feel strongly about the matter but it is still a fact that non-mob drug related incidents are the lowest of all nations that have a drug policy.

    By decriminalizing and proper education http://en.wikipedia.org/wiki/Spuiten_en_Slikken Dutch youth are very well informed on the dangers of drugs and are less inclined to use them.

    Individual towns are now considering growing pot themselves to decriminalize it even further and adding a handsome profit to taxrevenu.

  • http://www.blogger.com/profile/17401232760394588049 John

    “Although I agree 100 % with what you wrote after that I cannot agree with your forst sentence because studies are showing just the opposite MIGHT be true”

    Yes, I've seen studies showing that shizophrenics smoking pot were doing better on cognitive tests than the medicated, that non-medicated patients were showing less decline over time than medicated patients. Lots of problems here with the data, especially given spontaneous recovery does occur(there are studies on that). Overall though Ivana, for the time being at least, antipsychotics are all we've got and do help.

    As to what is schizophrenia. Oh let's not go there today, it could take months to come to terms with the mess of that diagnosis. We should drop the word and start finding new words and ways to think about schizophrenia.

  • http://www.blogger.com/profile/01866791882715154854 LeoB

    John, Ivana and others. Can you please post links or DOI for some studies that are interesting here?

  • Ivana Fulli MD

    John,

    To take a cool and simple example outside of psychiatry:

    Even in USA, it has been a long time since the last shoes shopkeeper has used an X RAY machine to measure children's feet length

    (I read about that fact in a “The Economist” a couple of years ago.)

    But, at least in France, many a child who comes to an emergency hospital room after a head trauma will get a useless cranial X-ray

    ( you need a clinical examination of the child and if abnormal a simple cranial X-ray is not enough, on the contrary it is also useless.You might want to keep the child under observation for a period of time but you will never need the X-ray)

    See my point John? I am not against X-ray, still useful tool in other cases and situation.

    But a shop keeper could be jailed in the XXI century for submitting children to radiation in order to choose a better fitting shoe but to irradiate a child with a useless X -ray is a doctor prerogative.

    Am I the only one who think that something is wrong here?

    I respect what you wrote, John, when commenting different posts of Neuroskeptic. Were you not the one denouncing hubris in our psychiatrist ranks?

    PS: I already wrote commenting another post of NS that:

    before crying out against antipsychotics you should listen to a young man happy to have gain 30 KG for getting rid of terribly painful hallucinations about his rotten bones being dead before the rest of him.

    And I strongly agree with PJ (or whatever is the nightwear initial pseudo of his) that one is here for a shock if one think that you can cure an acute agitated psychotic person by offering him a nice flat's keys to live in after the police had bring him at the emergency room.

    I agree then with PJ and yourself that we are lucky to have antipsychotics as a tool

    but it is not the only tool we have as soon as the acute agitated phase has been treated with antipsychotics .

    On the long term social support and fighting against social stigma, good psychotherapy by really supportive people, physical health and activity have their role, also sometimes hormonal treatment may be a little help.

    Also to my mind a non paternalistic discussion with the psychiatrist about the antipsychotic treatment.

    I also would like to know more about what makes a person hear voices or suffer delusions and live a normal social life and distance themselves from it when other are overwhelmed by the voices or the delusion and arrive at the emergency room.

    It seems difficult –with at least in GB and France mandatory outpatient care- that we will know anytime soon if really antipsychotics are bad for long-term outcome.

    May be antipsychotics are symptom suppressing -that we agree we are glad to have-

    but may be antipsychotics are a double-edge sword like antipyretics who are suppressing the fever and pain in infectious disease but also suppressing the disease fighting effect of fever.

    You do not want a child to suffer seizures from hyperthermia but you do not want the child to take too much antipyretic medication because you are afraid for his liver health with some antipyretics etc…

  • Ivana Fulli MD

    LeoB,

    The International Pilot Study of Schizophrenia: five-year follow-up findings
    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=5041696&fulltextType=RA&fileId=S0033291700032797

    “A five-year follow-up of the patients initially included in the International Pilot Study of Schizophrenia(…) Clinical and social outcomes were significantly better for patients in Agra and Ibadan than for those in the centres in developed countries. In Cali, only social outcome was significantly better.”

    For me it was food for thought.

    Leo, when you read studies about mental disorders, never forget the rule:

    “Rubbish in, rubbish out”

    To give a few tips and examples in addition to neuroskeptic good posts on big pharma and antipsychiatry and related subjects:

    1) autisms need a s and psychosis should take another one for plural. (see NS post dec 7 2011 and a father of autistic daughters first comment)

    2) DSMs are not scientifically sound: committees are electing groups of symptoms into becoming diagnostics and they vote to suppress some to the public outcry of the previous boss of that lucrative American enterprise

    Like the suppression of Asperger in DSMV proposals. Dr Bishop from Oxford is so glad that she considered it done since it helps her do statistics , trifle thing for her that a person had had no delay in acquiring expected behaviors during the first 3 years of life:
    http://deevybee.blogspot.com/2011/08/defence-of-susan-greenfield.html).

    The DSM makers were not above being accused to have make up the diagnostic of generalized anxiety disorder to find a marketing niche for a big Pharma drug…

    3) psychiatrists are notorious for not agreeing on diagnostic, Pr Terry Brugha chose to take psychologists with no experience in Asperger and trained them to do a good epidemiologic study his team published http://archpsyc.ama-assn.org/cgi/content/abstract/68/5/459?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=terry+brugha+asperger+in+GB&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

  • Ivana Fulli MD

    John,

    On the topic of long term outcome without antipsychotic drugs, Morrisson et al did a pilot open study:

    “Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial”

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8378447

    Only 20 people included (it is a pilot study) and those were refusing the antipsychotic drug treatment but presumably not refusing to have anything to do with the mental health system.

    Still, it is interesting to know more about CBT efficacy in that subgroup be it only for that population to be able to refuse antipsychotic drugs and still get support.

    Not likely though to answer which clients benefit from long term antipsychotic medication if any.

    I think we are in trouble ethically with mandatory psychiatric outpatient drug treatment in GB and France alike

    since we do not know really what we are doing long term with antipsychotic drugs treatment.

    -and academics on big pharma payroll claiming that our duty is to prescribe Zyprexa depot for life after the first psychotic episode…

  • Ivana Fulli MD

    petrossa 22 December 2011 18:09

    I agree that education of the youths is essential and I honestly do not have an opinion about cannabis legalization.

    Anyway, children not even teenagers have access to cannabis in France and what you wrote 22 December 2011 18:09 is congruent with what Pr Joseph White taught about the fact that prohibition of alcohol did increase crime.

    What I am concern about is the 2011 French law making psychiatry treatment mandatory for out patients and the French Minister of Education asking school to keep files on 3 years old with anti-social behavior and the fact that France is so baxkward in socila psychiatry and autisms.

  • Roger Bigod

    Ivana,

    You've made it plain that you would happily throw several 15-year olds in prison and impose the lifelong stigma of a criminal record in order to delay the onset of symptoms in one 25 year old with schizophrenia.

  • http://www.blogger.com/profile/17401232760394588049 John

    Ivana,

    Congratulations, you made me go data hunting(at my age the memory isn't what it should be)!

    There are a variety of approaches that can be used to address schizophrenia but logistical and economic issues are often more determinative of treatment protocols than what is best for the patient. That can be a bad thing but can also be a fact of life, we have to make our choices and in relation to mental health we're very good at making bad choices(who are the crazy people!?). For example, the below link, a BMJ editorial from 1996, argues that family interventions in schizophrenia is a neglected treatment avenue.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2351917/?page=1

    The link you provided indicated CBT is also useful. So we have a range of treatment possibilities that are often ignored. Is it just about time, money, and resources? Then there is this little mystery:

    1. Schizophr Res. 2011 Aug;130(1-3):222-7. Epub 2011 May 31.

    Differential effects of chronic cannabis use on preattentional cognitive functioning in abstinent schizophrenic patients and healthy subjects.

    INTRODUCTION: A number of studies indicate a higher risk for psychosis as well as for neurocognitive deficits in healthy cannabis users. However, little is known about the impact of cannabis use on outcome in schizophrenia. In fact, there is growing evidence that cannabis-using schizophrenic patients may show preserved or even better neurocognitive performance compared to schizophrenic non-users.

    PMID: 21624823 [PubMed - indexed for MEDLINE]

    Now given the potent neuroprotective properties of cannabinoids, especially with respect to modulating inflammation, and that in a subset of psychotics there is evidence of neocortical inflammation prior to a psychosis episode, it is possible to construct an understanding of why cannabis is helping some schizophrenics.

    Here's the problem, and I think it is one that ruins a lot of research into schizophrenia:

    Schizophr Bull. 2010 Jul 25. [Epub ahead of print]
    The Impact of Cannabis Use on Cognitive Functioning in Patients With Schizophrenia: A Meta-analysis of Existing Findings and New Data in a First-Episode Sample.

    Together, these findings suggest that patients with schizophrenia or FEP with a history of cannabis use have superior neuropsychological functioning compared with nonusing patients. This association between better cognitive performance and cannabis use in schizophrenia may be driven by a subgroup of “neurocognitively less impaired” patients, who only developed psychosis after a relatively early initiation into cannabis use.

    PMID: 20660494 [PubMed - as supplied by publisher]

    As a study I read years ago suggested, people who develop schizophrenia subsequent to cannabis use might represent an unusual subset. “Schizophrenia” and perhaps “psychosis” tries to explain too much. We need better categories. Unfortunately the lumping of patients together in these studies can simply lead to worse than useless data because it becomes misleading and confusing.

  • Ivana Fulli MD

    Dearest Roger,

    I am against pregnacies in twelve years old girls.

    That doesn't makes me against any woman bearing a child.

    And I do not believe that pregnant twelve years old girls should go to jail.

    Unlike you I believe in honest discussion and in education.

    You obviously, dearst Roger, are one for simplistic propaganda.

    I hope you are not a neuroscientist.

    PS: petrossa,
    I believe that Holland is obviously doing much better thant GB for preventing teenagers getting pregnant.

  • Ivana Fulli MD

    John,

    Thank you for answering me.I have to cook for Christmas and my answer will be just a few thoughts.

    1) Neuroskeptic did recently a post on CBT trials worth reading.

    CBT is not a religion like some psychoanalytic French sects of sort and it is a good point.

    But there are faddish therapies outhere reinventing the wheels be it from ancient meditation practices from Asia great cultures and religions or reinventing just basic spirituality like having a scope in your life.

    2) For cannabis I agree, probably only a minority of people put their inner peace of mind in jeopardy and trisk psychosis consuming cannabis.

    It is one of the reasons I dislike so much the DSM V proposal spectrum in autism:

    Every study will loose sensitivity if the groups you study are a mix of high functionning autism persons and Asperger.

    Idem for epidemiologic studies looking for causations.

    Dr Bishop from oxford seems on that point a clear example of what can make that DSM V spectrum appears:

    It is an easier way to do stats just ignoring how heterogeneous your groups studied are…

    3) about social psychiatry, there is much to be done and France is very backward.

    May in the USA far too much scizophrenic persons are homeless but in France it is a scandal that some people are not allowed out of psychiatric non academic wards for years and years. our system is crazy also because the academics have their training in academic services and have no experience of the non academic hospitals since they have passed a more difficult exam that the one to be a resident and then a consultant or chief of service in a non academic hospital.

    I will go and visit my friend Antonio Maone: not glamorous work but helping schizophrenic persons to have the keys of their house “le chiave di casa”

    Maone A. (2006), Le chiavi di casa. Possibilità e limiti dell’approccio di Supported Housing, «Psichiatria di
    Comunità», vol. 5, n. 4, pp. 222-235.
    Maone A., Ducci G., Lombardi F., Rossi E., Stentella C. e Vasques P. (2002), Day programs in Italy for
    persons with severe mental illness: a nationwide survey, «International Journal of Mental Health», vol.
    31, pp.30-49

  • Roger Bigod

    “And I do not believe that pregnant twelve years old girls should go to jail.”

    But you do believe that 15 year olds who smoke cannabis should go to jail and carry a lifelong stigma as criminals for the benefit of individuals at risk for schizophrenia. I don't find this amusing, so perhaps you are correct in accusing me of lacking a sense of humor.

    I hope that you are not a human being. A bot would be more interesting.

  • Ivana Fulli MD

    Dearest Roger,

    I am also strongly against sex between and adult and a 7 years old girl be it his daughter or grand-daughter or a sex slave in Cambodgia or whatever.

    I am not against sex in general because I oppose the rape of 7 years old girls except from some old pervert point of view, dearest Roger.

    And by the way, I am disgusted by binge drinking of yound people and alcohol and cigarettes publicity aimed at a very young audience.

    NB: I am also strongly against sex catholic priests forced upon altar boys.

    I was strongly against mother Theresa because she opposed contraception and abortion.

    Abortion should be safe, rare and free and not an usual contraceptive method -to my mind.

    Still, I think pope Benedetto XVI wrote very interestingly about the value of work-although he opposed contraception and abortion.

    That last sentence is not humour, nor it is irony, I am afraid.

    It is just that life is complicated.

    Merry Christmans dearest Roger

  • http://petrossa.wordpress.com/ petrossa

    Ivana

    What with minors running around rampant with military assault rifles i guess having some way of locking them up would be a godgiven.

    To my mind any kid who empties a ak-47 clip in a snackbar needs some serious treatment.

  • Ivana Fulli MD

    Petrossa,

    I think even dearest Roger will admit that war guns are not to be put in children or teenagers’ hands.

    I have no firm opinion about cannabis legalization (I guess I would be for it if the French ban on selling alcohol to young teenagers was really enforced)

    but I am 100% sure that selling war guns to war lords or criminals is a crime against humanity..

    Those responsible for children caring war weapons are warlords or criminal organizations.

    A human being has been killed in Southern France recently in an attack with war guns to rob frozen food!

    Many psychiatrists will agree with me that the crazy over prescription of anti psychotic medications is not likely to solve the problem of criminal violence with war guns in our western civilized peaceful nice countries like France or switzerland who sells and produces war material.

    NB: Only a minority of bloody crimes are committed by mentally ill persons be it with war gun or less mass deadly weapons.

    Those children and teenagers using war guns -be it as children soldiers or juvenile delinquents -need as much education as you can provide;

    and often are on street drugs and need to become clean.

    Finding and evaluating good ways of Rehabilitation and Education of juvenile delinquents is not making money like putting a new drug on the market, unfortunately.

  • Ivana Fulli MD

    Arid Psychiatrist,

    That article from the New York times put a pinch of salt on your comment, although the worst is done by GPs according to the investigative journalist:

    (…)Despite confusion about her diagnoses, there has been clear concern expressed in state records about the volume of drugs she was being given. None was more prevalent than Geodon, an antipsychotic made by Pfizer. Ms. Vargha protested after her sister, 47, was given as much as 360 milligrams per day; the maximum dosage recommended by the Food and Drug Administration is 160 milligrams. (…)”

    In:

    http://www.nytimes.com/2011/12/23/nyregion/potent-pills-few-rules-in-states-treatment-of-the-disabled.html?_r=4&adxnnl=1&pagewanted=all&adxnnlx=1325156139-QwDPk0pkT3bwD1kYIfzr/g

    NB: Pfizer pleaded guilty to misbranding Geodon (Ziprazidone)”with the intent to defraud or mislead” in 2009!!!!

    if short of time, there is a short comment on the NYT article in:

    http://healthland.time.com/2011/12/24/nyt-developmentally-disabled-in-new-york-are-getting-too-many-antipsychotics/?xid=healthland-daily

    “Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial:
    Background
    Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour.
    Methods
    86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks' treatment, which was recorded with the modified overt aggression scale (MOAS). Analysis was by intention to treat. This study is registered as ISRCTN 11736448.
    Findings
    80 patients had adherence of 80% or more to prescribed drug. Aggression decreased substantially with all three treatments by 4 weeks, with the placebo group showing the greatest change (median decrease in MOAS score after 4 weeks=9 [95% CI 5—14] for placebo, 79% from baseline; 7 [4—14] for risperidone, 58% from baseline; 6·5 [5—14] for haloperidol, 65% from baseline; p=0·06). Furthermore, although no important differences between the treatments were recorded, including adverse effects, patients given placebo showed no evidence at any time points of worse response than did patients assigned to either of the antipsychotic drugs.
    Interpretation
    Antipsychotic drugs should no longer be regarded as an acceptable routine treatment for aggressive challenging behaviour in people with intellectual disability.”

    In :
    The Lancet, Volume 371, Issue 9606, Pages 57 – 63, 5 January 2008

    doi:10.1016/S0140-6736(08)60072-0
    “http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60072-0/abstract

  • Ivana Fulli MD

    To all the shrinks and clients plus family members reading that wonderful blog and European citizens concerned about overprescription of antipsychotics,

    Beware that -until recently- European clients well enough to stay out of the psychiatric ward and not intensive care or surgery wards inpatient after suicide attempts or serious self-arm, could stop their medication.

    Not anymore since European union is all for out-patients mandatory care and at least in France and GB it became the national law.

    When we are not able to diagnose scizophrenia acuratly- not knowing even if it do exist.

    When inefficient expensive-good profit making drugs are prescribed by psychiatrists and GP working under the propaganda of Big Pharma with the myths that schizophrenia is for life, you need treatment for life in order to protect the brain of clients, antipsychotics are efficient to treat violent behavior in youth etc…

    In GB, I cite “Rethink”

    “Community treatment orders (also called CTOs) were first introduced in 2008. They were intended only for use in the most extreme cases. People subjected to the orders are made to follow a treatment plan and can be forced to go back into hospital if they do not comply.
    However, statistics published today show that in March this year, 3,270 people were subject to these orders.
    This is far beyond what the Government said would happen. And despite appeals from us and other mental health organisations, it seems no action has been taken against this repeated over-use.”

    Rethink CEO Paul Jenkins saidthat mental health professionals are:
    “…routinely putting anyone discharged from hospital onto these orders – this was never how they were intended to be used. Over three thousand people are currently having their rights deprived, many unnecessarily, just because they are ill.”

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Neuroskeptic

No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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