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? .

6.25: careers in psych:

"(

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:

"(Do Antipsychotic Drugs Influence Suicidal Behavior in Schizophrenia?)

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

Kaplan & Sadock's concise textbook of clinical psychiatry

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 .

psychlaws.org/briefingpapers/BP6.htm+suicide+medication+schizophrenia+rates

* 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 ?