2009-12-26

medical model for schizophrenia

6.6: todo.co.psy/schiz'ia/dopamine theory:
. if anyone who had money cared about schiz'ia,
they would take the psychiatric society to court,
asking where they get the idea
that schiz'ics have a dopamine excess .
"( . well, if they settle down after a dopamine reduction ...
)
. yea, well, raving freedom fighters settle down too!
so what? .

"(
Unfortunately, prejudice and discrimination
against the mentally ill still exists.
Sometimes this stigma is also directed against
those who care for the mentally ill.
Occasionally, even our colleagues in medicine
are unaware that
mental illnesses are real
(i.e., genetically and biochemically based)
and can be diagnosed and treated
with the same accuracy and effectiveness
as other medical illnesses.
) .

6.25: psych.org`maximizing pharm in schiz'ia:

MAXIMIZING PHARMACOTHERAPY IN THE TREATMENT OF
SEVERE AND PERSISTENT MENTAL ILLNESS:
The Case for Maintaining Open Access to
Medically Indicated Medications for Schizophrenia
. The Office of Healthcare Systems and Financing
American Psychiatric Association
March 2004

"antipsychotics", so named for their initial use in treating
the classical psychotic delusions and hallucinations associated with schizophrenia.
Today these medications are increasingly prescribed to treat
many severe and persistent mental illnesses,
among them bipolar disorder, psychotic depression,
and aggressive conduct disorders.

Indeed, for patients with schizophrenia,
limitations on access to the most effective
and appropriate medications available results
not only in incomplete recovery and potential relapse,
but carries significant risk of death
as persons with schizophrenia are at significantly higher risk of
suicide compared with the general population.

As positive symptoms decrease, the risk of self-harming behaviors
(including suicide risk) decreases
and disturbed behaviors are controlled

. after reading that, I had to ask:


The literature concerning the net effect of antipsychotic medication
on suicidality in patients with schizophrenia
is not consistent.
This review assesses this problem in the light of relevant research.
MEDLINE was used to search for articles written in English from 1964 to 2006
. Articles were classified according to the following three orientations:
positive, negative, or null effect on suicidality
. Several inconsistencies among the studies
and methodological difficulties appeared
and a singular conclusion on this issue was not possible.
Competing properties of various antipsychotic drugs
may have differential effects on suicidality.
Second-generation antipsychotic agents
appear to have a better potential for preventing suicide in schizophrenia,
but the relative profile of each drug is yet to be clarified.
A good profile to treat hostility, impulsivity, and depression
while not provoking extrapyramidal side effects
is crucial when choosing an antipsychotic in the presence of suicide risk.
The strongest and perhaps unique evidence
has been shown for clozapine,
which seems to have a clinically relevant advantage over both
first- and second-generation antipsychotics for reducing suicidality.

. the drugs being used for schiz'ia are also being used for
aggressive conduct disorders .
. there's no magic, these drugs plain knock the crap out of you .

"(
. for many patients with schizophrenia
and other persistent and severe mental illnesses,
it is inherently difficult for them to take their medications to begin with
. Some estimates say as high as 70 percent to 80 percent of patients with schizophrenia
do not take their medications as directed by their physicians.
The reasons are numerous and complex, including patients' poor insight,
cognitive deficits
and mood symptoms that are part of the disease process.
Also high on the list of significant barriers to
patients consistently taking their medications
are the often significant side effects
associated with antipsychotic medications.
) -- March 2004 ? American Psychiatric Association Page 5

. how could clozapine be an improvement?
when they don't make you feel like crap,
they are literally killing you with kindness:
creating a feeling of well-being by raising blood sugar
and creating the same risks presented by diabetes .

"(
Assessment for medical causes of a patient's symptoms of psychosis
is especially important because numerous medical conditions
may present with psychosis, including Cushing's syndrome,
epilepsy, brain tumors, traumatic brain injury,
and metabolic disorders .
)
--. this gave me the idea that some of the diff's in types of schiz'ia
may be due to the schiz'ic process causing various degrees of stress
which in turn cause various degrees of metabolic disorder
(eg, blood sugar that is too low) .

(Zyprexa) in 1996, quetiapine (Seroquel) in 1997,
and ziprasidone (Geodon) in 2001.
With the introduction of aripiprazole (Abilify) late in 2002,
the third generation of antipsychotics was born.
The single third-generation drug works through a significantly different mechanism:
partial agonism at D2 receptors. [rather than
full antagonism]
As a partial agonist, when levels of dopamine are high,
aripiprazole blocks dopamine receptors, reducing dopaminergic activity.
When levels of dopamine are low, the drug boosts the sensitivity of the receptors
to the dopamine that is available.
The same relationship is true for aripiprazole's interaction with
specific types of serotonin receptors.
As a result, some refer to the drug as a dopamine/serotonin system stabilizer.
An emerging theory proposes that
blockade of dopaminergic activity at D2 receptors specifically within the
meso-limbic area of the brain Ð known as the A10 dopaminergic tracts Ð
is related to antipsychotic action.
Binding to D2 receptors in other areas of the brain
is related to side effects,
such as EPS and increased levels of the hormone prolactin.

A substantial body of research now indicates
that each of the available second-generation antipsychotic medications,
as well as the first of the third-generation medications,
has been proven to possess clinically significant differences
from the other medications within the therapeutic class.
Individual patients' response to different medications is variable,
as is the risk of side effects.
Therefore, it is absolutely critical that physician's closely match
a specific medication to each individual patient's needs.


in 2003, the U.S. FDA approved a formal indication for clozapine
for the treatment and prevention of suicidal ideation and behaviors.
--
. has anyone been able to use clozapine
without adversely affecting blood lipids
(as an indicator of metabolic disorder
and a predictor of heart disease) ?
perhaps it's suicide either way:
it doesn't matter if the suicide was nipped,
since statistically that drug is sure to be a homicide .

according to

80% of alcohol-dependent suicides
and the subgroup of depressives most likely to suicide
belong to males during middle-age
that are unmarried, friendless, and socially isolated .
. this is the primary subgroup of the suicidal schiz'ics too,
but at a younger age .
. these are termed egoistic suicides,
being preceded by social death .
. generally the key is hopelessness:
suicide is higher among professionals,
and this may be that there's more reasons forcing one to step down,
while at the same time,
being that high make one prefer stepping out to stepping down .

* Estimates of the completed suicide rate for individuals with schizophrenia
range from 10 to 13 percent.
Caldwell C and Gottesman I. Schizophrenics kill themselves too:
a review of risk factors for suicide. Schizophrenia Bulletin 16:571-589, 1990.
* This rate is at least four times higher than
similar studies from the period from 1913 to 1960,
suggesting that the suicide rate has risen markedly since
massive deinstitutionalization began.
Stephens J et al.
Suicide in patients hospitalized for schizophrenia: 1913-1940.
Journal of Nervous and Mental Disease 187:10-14, 1999.
* A case control study of 63 individuals with schizophrenia
who committed suicide and 63 individuals with schizophrenia who did not
reported that "there were seven times as many patients who
did not comply with treatment in the suicide group
as there were in the control group."
De Hert M et al.
Risk factors for suicide in young people suffering from schizophrenia:
a long-term follow-up study.
Schizophrenia Research 47:127-134, 2001.
--
. after reading that,
it occured to me that they had a case of selection bias:
. the one's who were "(willing) to be medicated,
were doing so against their will;
ie, they would be punished for not doing so;
and those who did commit suicide
had actually been pushed into suicide by meds;
ie, you can either be tortured by this mommy-dearest meds treatment,
or you can step out .
. another hypothetical situation
would simply make the meds irrelevant:
when things are hopeless eno' to take your own life,
you're exactly the one who's less likely to
comply with others' demands .

* Studies have suggested that some antipsychotic medications,
and especially lithium, may decrease the incidence of suicide
among individuals with severe psychiatric disorders.
Tondo L et al.
Lithium and suicide risk in bipolar disorder.
Primary Psychiatry 6:51-56, 1999.
* A Swiss 34-year follow-up study of 158 individuals with bipolar disorder
reported that 18 of them (11 percent) had committed suicide.
The suicide rate was more than twice as high among
patients who had not been treated
compared to those who had been treated (p = 0.04),
a difference the authors called Òspectacular.Ó
Angst F, Stassen HH, Clayton PJ et al.
Mortality of patients with mood disorders: follow-up over 34-38 years.
Journal of Affective Disorders 68:167-181, 2002.
8.25: psy/religion is not delusional:
. the dsm gives specific examples of non-provable things
that are proof of delusion;
but gives exception to cases where the delusional people
happen to be agreeing with their culture's religious beliefs .
. the main point of this
is not to cast a shadow on religion as being delusional;
rather, it is giving perspective or context
to the intent of the definition:
. we are concerned about giving a diagnostic label to
disorders involving delusion;
whereas, religiously or culturally sanctioned delusions,
are by definition a sociable, orderly act .

10.27: todo.psy/schiz'ia/the science of policy:
. in the current theory
that discounts spiritual or telepathic communications
there is no way to differentiate
a schiz'ic hearing voices of being yelled at
from those who stay quiet about such yelling
due to an understanding that
it's a private domestic dispute
or it's a vigilante action against one who broke a taboo .


11.13: news.psy/metapsychology.mentalhelp.net:

. metapsychology.mentalhelp.net gets a bad review from mywot.com:

. here is a Review of Doctoring the Mind: Is Our
Current Treatment of Mental Illness Really Any Good?
While a lot of criticism of psychiatry's approach
has recently come from within the profession itself,
stopping short of criticizing psychiatry itself, Bentall, a psychologist,
and a Professor at Bangor University in the UK,
takes on psychiatry for its failure to improve the mental health of nations
since its entry into the world of intervention.
Bentall is part of the antipsychiatry movement
whose first major players, Cooper, Laing, Szasz
were themselves disillusioned psychiatrists,
although their reasons and styles were different.
This does not mean he is against psychiatry:
like Miller and others he is merely questioning the way it all works.
Or rather, doesn't .

bone of contention that psychiatric nurses with psychologists
Doctoring the Mind by Richard P Bentall (Hardcover - 25 Jun 2009) review
I work as a psychiatric nurse on a intensive care ward
and have often been in the centre of power struggles
between psychologists and psychiatrists.
From my experience,
Psychologists seem to believe in the ubiquitous efficacy
of dialectical/cognitive behaviour therapy
as a treatment for severe mental illness.
For example, mindfulness meditation
as a treatment option for Bipolar Affective Disorder.
Psychiatrists spend 10 minutes a week with patients
and take a medical model approach eg, assessment, diagnosis and treatment.
However in fairness,
psychologists spend even less time with inpatients.
The bone of contention that psychiatric nurses have with psychologists
involves their inability to understand the concept of risk
and consequently risk management.
They only promote the therapeutic interactions.
Sometimes however, nurses have to manage risk
which sometimes involve difficult and dangerous situations.
However, often nurses are blamed for the patients acting out behaviour
due to insufficient therapeutic skill.
This often causes burn out in nurses
and leads to a profession feeling devalued.
my response:

. the real bone of contention that psychiatric nurses have
is not with psychologists but with politicians .
. there are young patients on many wards,
including intensive care units,
for nothing more than being a drug abuser
and an authority fighter
-- basically a product of grossly asocialized parenting .
. the line we draw between criminals and psychotics
is ludicrous;
and being a psychiatric nurse is really all about
taking these obvious criminals
and beating them into submission
in such a civilized way, with drugs
that actually cause such hormonal imbalance
as to knock all the fight out of the aggressors .
. there's no more burn-out in psychiatric nurses
than there is in prison guards:
it's the same stupid work,
giving the same aweful result !
. this is why the psychiatrist is your best friend,
medications are a prison guard's best friend .
. if we had all the money we wanted,
we could give the self-abusive mind
a nice isolation unit,
perhaps some pleasant recreational drugs,
or whatever good money can think of;
and, if they still continued to abuse themselves
then let them go wherever self-abuse takes them .
. this sad conclusion
is where the psychologist is your best friend:
they have the science that may help us
with prevention of self-abuse and crime
rather than this ridiculously ineffective patching-up
of the social suicides .

11.14: web.psy/books about pschiatry being self-critical:

. notice books similar to recent: ...
Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good?
by Richard P. Bentall

by Thomas Stephen Szasz (psychiatrist):
Coercion as Cure: A Critical History of Psychiatry
The Medicalization of Everyday Life: Selected Essays
The Myth of Psychotherapy: Mental Healing As Religion, Rhetoric, and Repression
The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (Revised Edition)
Psychiatry: The Science of Lies

Szasz Under Fire: The Psychiatric Abolitionist Faces His Critics
by Ph.D. Jeffrey A. Schaler (Editor)

Ethics of Psychiatry: Insanity, Rational Autonomy, and Mental Health Care
by Rem B. Edwards (Editor)
The Medicalization of Society:
On the Transformation of Human Conditions into Treatable Disorders
by Peter Conrad
Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace
the Drugs, Electroshock, and Biochemical Theories of the "New Psychiatry"
by Peter Roger Breggin
Blaming the Brain: The Truth About Drugs and Mental Health
by Elliot Valenstein (Author)
Rethinking Psychiatric Drugs: A Guide for Informed Consent
by Grace E. Jackson
The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment
by Joanna Moncrieff

11.27: pol/dr.psychi/is someone chasing you?:
. going from lobotomy being unpopular
to meds that lobotomize discretely,
by testing the drugs for short durations;
and, then insisting that the meds only work with sustained use
which is followed by the unfortunate sideaffect
of frontal atrophy .
. but doesn't dr.psychi really medicate our culture's
secret addiction ?
that of always being chased by a weakness for
money-burning overpopulationism ?
. sanity is god's way of saying
I want more of this ...
where's the army of homeless coming from?
has-beens (mental, criminal, ... untrustable or taboo).
. it's not ok to encourage suicide,
but is ok to encourage tb and other diseases?
have you seen the cost of housing inmates in isolation
-- no need for guards that would be more inhumane
can't possibly work for all this musical chairs sweatiness,
insanity might be god's too ?
other behaviors ?