The Anti-Psychotic Myth Exposed?

Psychminded.com ^ | 4/2/08 | Adam James

[bdeaner]

Anti-psychotics are not effective long-term, shrink the brain and almost triple the risk of dying early, a London NHS psychiatrist and academic has written in a new book. Isn't it about time for a deep examination of the validity of such drugs asks Adam James?

.....

Christian was slouched in a chair in Bradford psychiatric unit. He was, seemingly, only half-conscious, half alive. He could hardly speak, let alone raise his head.

Christian had been diagnosed with schizophrenia. Two days before, in a haze of paranoia, he had punched a colleague of mine at a day centre. So Christian was sectioned and medicated, heavily, with neuroleptics. Most, on seeing Christian would have described him as being so whacked out he was a dribbling wreck. Treatment-advisory body, the National Institute of Health and Clinical Excellence (Nice) would say the neuroleptics had successfully “calmed” Christian, in preparation for treating the “underlying psychiatric condition”.

Neuroleptics – such as Clozapine, Olanzapine, Risperidone and Seroquel – are the “primary treatment” for psychosis, particularly schizophrenia. Indeed, 98-100 per cent of people diagnosed with schizophrenia inside our psychiatric units – and 90% living in the community – are on neuroleptics, also called anti-psychotics. “There is well established evidence for the efficacy of anti-psychotic drugs”, Nice told mental health professionals in its guidelines for the treatment of schizophrenia.

Nice claims a similar efficacy for the widely-prescribed SSRI anti-depressants in treating depression. Some researchers disagree. A recent widely-publicised meta-analysis asserted that SSRIs are no more clinically beneficial than placebo for mild and moderate depression. London NHS psychiatrist Joanna Moncrieff is one such dissenting researcher. But she has conducted a far wider examination of psychiatric drugs, and has endeavoured to expose the “myth” of anti-psychotics. She claims there is no sufficient evidence to support their long-term use and they cause brain damage, a fact which is being "fatally” overlooked. Plus, because of a cocktail of vicious side-effects, anti-psychotics almost triple a person’s risk of dying prematurely.

Moncrieff, also a senior lecturer at University College London, particularly strikes out at her own profession, psychiatry, claiming it is ignoring the negative evidence for anti-psychotics. In her book, The Myth of The Chemical Cure, Moncrieff argues the increasing prescribing of these drugs is unleashing an epidemic of drug-induced problems. She argues, effectively, that psychiatry is guilty of gross scientific misconduct.

Having scrutinised decades of clinical trials, Moncrieff's first point is that once variables such as placebo and drug withdrawal effects are accounted for, there is no concrete evidence for antipsychotic long-term effectiveness.Moncrieff’s interpretation of the relevant meta-analyses and trials is radically different to Nice which arrived at an opposite conclusion for antipsychotic effectiveness.

At the heart of dissent against psychiatry through the ages has been its use of drugs, particularly anti-psychotics, to treat distress. Do such drugs actually target any “psychiatric condition”. Or are they chemical control, a socially-useful reduction of the paranoid, deluded, distressed, bizarre and odd into semi-vegetative zombies? Historically, whatever dissenters thought has been largely ignored. So, it appears, have new studies which indicate anti-psychotics are not effective long-term. For example, a US study last year in the Journal of Nervous and Mental Disease reported that people diagnosed with schizophrenia and not taking anti-psychotics are more likely to recover than those on the drugs. The study was on 145 patients, and researchers reported that, after 15 years, 65 per cent of patients on anti-psychotics were psychotic, whereas only 28% of those not on medication were psychotic. An intriguing finding, surely? So what about the mainstream media headlines of “breakthrough in schizophrenia treatment”? Afterall, broadsheets react positively to the plethora of alleged genetic "breakthroughs" in schizophrenia, even when it comes to genetically-engineered schizophrenic mice. But there wasn't a squeak.

Interestingly, the researchers of the Journal of Nervous and Mental Disease paper hypothesised that it was patients with "inner strength”, “better self esteem” and “inner resources” who were more likely to recover long-term without neuroleptics. However, not one peer-reviewed study examining the necessary individual characteristics and support networks to live through psychosis without drugs has, in the last 48 years, appeared in The British Journal of Psychiatry, the publication that each month drops through the letter box of every psychiatrist in the land.

The “psychological factors” of, for example, inner strength, are, perhaps more the terrain for clinical psychologists. Such as Rufus May who was compulsory treated with anti-psychotics when diagnosed with schizophrenia as an 18-year-old.

May argues withdrawal effects of anti-psychotics often get wrongly interpreted as “relapse”. So, he has launched a website advising people how safely to come off psychiatric drugs. Many patients, like May (who perhaps had the required "inner strength”), have successfully come off anti-psychotics and gone on to recover. The irony is that they frequently have had to do it behind the backs of their psychiatrists, who fear relapse.

Moncrieff’s second point is that the psychiatric establishment, underpinned by the pharmaceutical industry, has glossed over studies showing that anti-psychotics cause extensive damage, the most startling being permanent brain atrophy (brain shrinkage) and tardive dyskinesia. As in other neurological conditions patients suffer involuntary, repetitive movements, mental impairment, memory loss and behaviour changes. Brain scans show that anti-psychotics cause atrophy within a year, alerts Moncrieff. She accuses her colleagues of risking creating an “epidemic of iatrogenic brain damage”. Moncrieff is a hard-nosed scientist, so she is respectfully reserved. But her carefully-chosen words are still alarming. "It is as if the psychiatric community can not bear to acknowledge its own published findings,” she writes.

How worrying it is, also, that the Healthcare Commission should report last year that almost 40 per cent of people with psychosis are on levels of anti-psychotics exceeding recommended limits. Such levels cause heart attacks. Indeed the National Patient Safety Agency claims heart failure from anti-psychotics is a likely cause for some of the 40 average annual “unexplained” deaths of patients on British mental health wards. Other effects of anti-psychotics include massive weight gain (metabolic impairment) and increased risk of diabetes. Two years ago, The British Journal of Psychiatry - Britain’s most respected psychiatry journal - published a study reporting that people on anti-psychotics were 2.5 times likely to die prematurely. The researchers warned there was an “urgent need” to investigate whether this was due to anti-psychotics. But so engrained is the medication culture in mental health that many psychiatrists regard that not medicating early with anti-psychotics amounts to negligence, Moncrieff notes.

Moncrieff does acknowledge there is evidence for the short-term effectiveness of anti-psychotics. But again Moncrieff asks psychiatry to be honest. Moncrieff points out that when anti-psychotics, such as chlorpromazine, were first used in the fifties they were called “major tranquillisers.” Why? Because that’s an accurate description of their effect, particularly short term. They sedate, numb, or tranquillise, the emotions, so reducing the anxiety of paranoia and delusions. Any person on anti-psychotics would verify this (Go to askapatient.com). So, in this respect, they are effective. Nowadays, however, these drugs are referred to as “anti-psychotics”. For Moncrieff, this is a wheeze because there’s no evidence that anti-psychotics act directly on the “symptoms” – paranoia, delusions, hallucinations – of those diagnosed with psychosis. There’s nothing anti-psychotic about anti-psychotics.

Embedded in Moncrieff’s thesis is that, unlike other medical conditions, there is no evidence that psychiatric illnesses, including schizophrenia, are caused by physical abnormalities. As clinical psychologist Mary Boyle penned it, schizophrenia is a "scientific delusion” which drugs can never cure.

The alternatives? Moncrieff - like her fellow psychiatrists in a group called the Critical Psychiatry Network - asks services to look seriously at non-drug approaches, such as the Soteria Network in America. She believes psychiatrists such as herself should no longer have unparalleled powers to forcibly detain and treat patients with anti-psychotics. Instead, they should be “pharmaceutical advisers” engaging in “democratic drug treatment” with patients. Psychiatrists should be involved in “shared decision-making” with patients, and would have to go to civil courts to argue their case for compulsory treatment. "Psychiatry would be a more modest enterprise” writes Moncrieff, “no longer claiming to be able to alter the underlying course of psychological disturbance, but thereby avoiding some of the damage associated with the untrammeled use of imaginary chemical cures.”

Mental health policy is, it appears, swinging away from a reliance on antidepressants. Surely a deep re-examination of the true validity of anti-psychotics is also due?

[bdeaner]

FYI

[NonValueAdded]

Plus, because of a cocktail of vicious side-effects, anti-psychotics almost triple a person’s risk of dying prematurely.

Ah, but tripled from what baseline? that of a typical "healthy" person of the same age and gender or that of an unmedicated person with the same psychosis? (ses?).

If the question came down to "you are a clear danger to yourself and the community. We can sequester you in a hospital or, with the use of anti-psychotics, can let you rejoin society but you might die sooner," which do you choose? That's a whole different kettle of fish. I don't see the article being clear on that.

"What? time for another pill? just a second while I post this ..."

Later, FRiends :)

[pieceofthepuzzle]

Whereas anti-psychotics are probably over-used, and inappropriately used in many instances, they can and do help truly psychotic patients. I have personally seen a schizophrenic who thought aliens were after him totally revert to reality and what would pass with pretty much anyone as normal cognition and behavior in about a day after receiving an effective anti-psychotic. Patients who have abnormal brain chemistry can be markedly helped by the right medications. The problem is that psychosis is a wastebasket diagnosis that probably includes a large number of different syndromes and causes. The same drug may work for one person, but be ineffective, harmful, or totally inappropriate for others. Haldol has been way overused and has been given very frequently to elderly patients who became confused during hospitalization. That is inappropriate and very unfortunate.

[Zevonismymuse]

Tardive Dyskinesia is practically inevitable if a person remains on the drugs long enough. I worked in locked psych for many years and I agree with most of the points made in this article. In my experience most psychosis has a very young age of onset, usually in late teens or early twenties and people tend to cycle out and have diminished symptoms after a period of a few to several years depending on the severity of their symptoms. In many cases the side effects of these drugs is worse than the illness being treated. And to the best of my knowledge the damage done to the brain is not reversible. This is a serious and complex issue. People who are psychotic can be a danger to themselves and others but I believe we have the ability to devise more civilized treatment approaches in the treatment of the mentally ill.

[Starfleet Command]

People who are psychotic can be a danger to themselves and others but I believe we have the ability to devise more civilized treatment approaches in the treatment of the mentally ill.

In America, we typically elect them.

[Zevonismymuse]

Haldol has been way overused and has been given very frequently to elderly patients who became confused during hospitalization. That is inappropriate and very unfortunate.

While I was typing my first reply I was thinking about how Haldol has been used routinely to manage dementia in nursing homes. It is a terrible drug for the elderly. I agree with you that there is a time and a place for psychotropic medications but I became very frustrated with the treatment of patients in locked mental wards.

[Hank Kerchief]

“Patients who have abnormal brain chemistry can be markedly helped by the right medications.”

Can you name a single scientific study that has identified any abnormal brain chemistry with any identified psychosis or neurosis, and what the specific chemical imbalances are?

You cannot. There has never been one. This is entirely fiction.

Hank

[hinckley buzzard]

I believe we have the ability to devise more civilized treatment approaches in the treatment of the mentally ill.

Name one. Wiser people than you have been trying for a century or more and come up with precious little.

We could go back to the 'treatments' in use prior to the introduction of Thorazine in the 1950's. I don't think you would like your loved one to be treated that way.

[Quix]

Note.

[blueplum]

well, it would seem one would have to add some version of, the psychiatric establishment, underpinned by the pharmaceutical industry, has glossed over studies showing that anti-psychotics cause extensive damage, the most startling being permanent brain atrophy to that question for a truely informed consent to be obtained.

[Al B.]

Wiser people than you have been trying for a century or more and come up with precious little.

We could go back to the 'treatments' in use prior to the introduction of Thorazine in the 1950's. I don't think you would like your loved one to be treated that way.

Well, if you're talking about psychiatric "treatments" such as ice picks driven through eye sockets to lobotomize victims, I would agree with you.

My aunt was on Thorazine for 15 years back in the 50's and 60's. She developed tardive dementia and died at the age of 54 as a complete vegetable. I wouldn't want anybody else's loved one treated that way either.

You and I have gone round and round on this in years past and I don't intend to start again, but I agree with you on the "precious little" comment because that's what the sum total of psychiatric solutions over the years amount to from my vantage point....precious little.

[Zevonismymuse]

I don't think you would like your loved one to be treated that way.

You make many assumptions based on a few sentences. I do recognize that it is a very complicated situation. My loved one would have me for an advocate where as many of the people I dealt with were being warehoused. I take responsibility for my family so I would have the luxury of trying less harsh drugs and approaches. I realize this would not be practical in most cases. I have some ideas that I do want to get into here. I was simply agreeing that the long term side effects of many of the anti-psychotic medications is a tragedy and worth discussion. This is a site where people discuss articles. No need to get aggressive.

[bdeaner]

The problem is that psychosis is a wastebasket diagnosis that probably includes a large number of different syndromes and causes.

This is a good point. A huge problem is the lack of reliability and validity in the DSM diagnostic system. It's difficult to predict how a particular class of drugs will work, of even if drug treatment is necessary, when there is so much heterogeneity -- and massive error/variability -- in the diagnostic data.

[bdeaner]

Name one. Wiser people than you have been trying for a century or more and come up with precious little.

We could go back to the 'treatments' in use prior to the introduction of Thorazine in the 1950's. I don't think you would like your loved one to be treated that way.

Perhaps you haven't dug far enough into the history. Between the horrors of Bedlam and the disasters of modern psychiatry, there were the moral treatments of the 18th century, which actually were very successful (albeit potentially quite costly to implement and maintain).

For the sake of brevity, let's just stick to the moral treatments in the U.S. which were inspired by the progress made by Pinel and Tuke in Europe. The basic idea here was that the mad had an inner capacity for regaining self-control, for recovering their reason. The ultimate source of their recovery lay inside themselves, and not in the external powers of medicine.

The first moral treatment asylum was opened by the Philadelphia Quakers in 1817, and others followed. McLean Hospital opened in 1818, in New York City in the year 1821 Bloomingdale Asylum opened where you can now find Columbia University, and Hartfored Retreat opened in Connecticut. Etc.

These places kept relatively few patients -- no more than 250 at any single facility. They were located in the country, surrounded by flowerbeds and gardens, where the mentally ill could take their fill of fresh air and find solace in tending to plants. They took great pains to design the architecture with the highest aesthetic values, mindful that patients are especially sensitive to environmental stimuli and uplifted by beauty and order. And perhaps most importantly, the superintendent of the facility was chosen in particular for his temparement -- reasonable, humane, possessing dignity and stability of character, mild and gentle, compassionate...

The patients were kept busy with activities -- gardening, playing games, educational pursuits. Theater groups performed; speakers were invited to give talks at meals. Restraints were used only as a last resort. They rewarded good behavior. Those who were disruptive were placed on ground floors furtherest from the social center of the asylum. Those who behaved got the preferred rooms on the top floor, and they were also given extra liberties. They were allowed to stroll about the grounds and were given the privilege of going into town, as long as they pledged not to drink and to return to the asylum on time.

This treatment appears to have been remarkably successful, according to modern historians. In the first decades of moral treatment, before the asylums were taken over by neurologists who changed everything, 35-80% of all admitted patients were discharged within a year's time, and the majority of those discharged were viewed as having been cured. That mean that their disturbing bheavior and psychotic thoughts had largely disappeared.

At Pennsylvania Hospital, during the tenure of Thomas Kirkbride, results were very good. Of 8,546 "insane" patients admitted from 1841 to 1882, 45% were discharged as cured, and another 25% discharged as improved. A long-term follow-up study of 984 patients discharged from Worcester asylum from 1833 to 1846, which was conducted in the 1880s, found that 58% had remained well throughout their lived. Another 7% had relapsed but had subsequently recovered and returned to the community. Only 35% had become chronically ill or had died while still mentally ill.

These results are far better than the terrible 8% recovery rate among schizophrenics in the U.S. today -- a statistics that pales even in comparison to recovery rates in third world countries that do not have anti-psychotics available for use.

[pieceofthepuzzle]

“This is entirely fiction.”

Your dogma is disturbing, and inaccurate. As I tried to point out, the clinical diagnosis of ‘psychosis’ includes a wide array of symptoms and likely a broad array of mechanistic causes. There have most certainly been many studies that have linked alterations in brain chemistry with alterations in mentation. How do you think LSD does it's thing? Do you not believe that alterations in brain chemistry affect perception and mood? Have you ever had a drink of alcohol? Do you believe that women experience mood shifts with menstruation-associated changes in circulating hormone levels? The list goes on and on. That a single gene or single receptor or single neurotransmitter abnormality that explains all or most psychosis has not been identified is not surprising, and is indicative of the complexity of the brain and the difficulty in understanding this incredible organ. What do you believe? Do you think schizophrenics just need a good talking to?

[gusopol3]

praecox dementia— the name for schizophrenia in the pre -drug era. Again the illnesses are serious and your attempts to minimize them are tragic and misguided.

[pollywog]

Tardive Dyskinesia is practically inevitable if a person remains on the drugs long enough.

This just breaks my heart to even read....

Long story.

We took a foster baby almost 30 years ago.He was deaf and had autism...we were at the mercy of neurologists not having any knowledge at all about the medications that he was being given.

Bottom line is he was " experimented with"...and we have had to go through a living hell with him ...and yes, he developed Tardive Dyskinesia because of the meds, NOT because of his conditions.

Would to God we had known. It breaks our hearts. He can hardly walk now. I hate these meds...

oh and the meds he was on for 5 years before we began to see the effects was Haldol!!!!

Now he can't get off of them. We have him in a special needs placement now. Broken hearted in Los Angeles...

Polly

[Hank Kerchief]

Instead of guessing what I believe or don’t believe, why don’t you just provide a citation to a single study that has ever established a chemical basis for any so-called psychosis or neurosis. If there is any evidence at all, that should be easy to do.

The argument is not about whether chemicals can affect the brain, but whether there are brain chemicals (or chemical imbalances) that cause “mental illness.” Two very different issues.

Hank

[Lucius Cornelius Sulla]

I didn’t realize that FR had become a Scientology haven. It might be useful to point out that before these drugs became available. the US was filled with mental hospitals filled with people under restraints. Now most of these people are functioning in society, and the mental hospital population is a fraction of what it was.

[pieceofthepuzzle]

Just using steroid-induced psychosis as an example, here are just a few of a ton of references about this one entity. There are many others.

1. Ingram, D. G. & Hagemann, T. M. Promethazine treatment of steroid-induced psychosis in a child(2003) Ann Pharmacother 37, 1036-1039.
2. Viswanathan, R. & Glickman, L. Clonazepam in the treatment of steroid-induced mania in a patient after renal transplantation(1989) N Engl J Med 320, 319-320.
3. Turner, P. Steroid-induced psychosis(1989) Lancet 2, 923.
4. Black, A. C. Biochemical mechanisms of steroid-induced psychosis(1982) N Y State J Med 82, 1024.

Although we clearly do not have a definitive answer to the mechanistic basis of many if not most mental diseases, we know with certainty that neural activity is rooted in a complex interplay between brain architecture, neurotransmitters, and a variety of related processes and factors. Why is it so difficult to accept that abnormalities in how these processes work or interact is at the basis of many severe psychiatric diseases? I'm not saying that brain chemistry abnormalities are the cause of all our failings, unhappiness, and poor judgment, but I do believe that there clearly are people who very unfortunately have abnormalities in brain chemistry and that this has a big effect on their mental health. Schizophrenics are on an extreme of that spectrum.

[Tidbit]

Can you name a single scientific study that has identified any abnormal brain chemistry with any identified psychosis or neurosis, and what the specific chemical imbalances are?

Here's one:

http://www.medscape.com/viewarticle/412177

The article first appeared in an October 2000 issue of the American Journal of Psychiatry.

You sound like Tom Cruise claiming there's no such thing as depression.

[bdeaner]

Again the side effects of these drugs are serious and your attempts to minimize them are tragic and misguided.

[Hank Kerchief]

Thanks for the link, but it says I have to log in to see it. Since I’d have to join something to see it, and I join nothing, you’ll have to either provide me a login name and password, or provide a copy of the content. I’d really like to see it.

It’s late for me, so I’ll not be here until the morning.

I’m not your enemy. I’m only interested in the truth.

Hank

[Tidbit]

These places kept relatively few patients -- no more than 250 at any single facility.

We have those places in the United States today. One of them is located at 1600 North Pennsylvania. Another is just down the road on East Capitol. I hear there's one in Cuba too, but unfortunately it's going to be closed. /s

[Tidbit]

Sorry about that. Here's a link to an open site. I don't think we're enemies, at least not until my Thorazine wears off. I was being tongue-in-cheek about Tom Cruise, sorta.

Evidence of Brain Chemistry Abnormalities in Bipolar Disorder

[bdeaner]

praecox dementia

By the way, your statement betrays a certain ignorance of the diagnostic issue on hand. The issue is one of drug treatment of PSYCHOSIS. Schizophrenia is only one of several mental disorders that include psychosis as a symptom. Bipolar Disorder, in its manic phase, often has psychotic features. There is a psychotic depression. There is psychosis secondary to drug use, including stimulants such as Ritalin and Adderal, not to mention anti-psychotic medication. Psychosis can be induced by a medical condition, such as a head injury or brain damage. There is brief psychotic episodes. Etc, etc.

The only disorder that has any historical link with the VERY outdated concept of dementia praecox is schizophrenia, and that description, from Kraplein, is of a particular kind of psychosis that is hebephrenic and progressively degenerative in nature -- unlike many other manifestations of symptoms in individuals diagnosed with schizoprenia, per DSM-IV criteria.

Do you claim to have any training in psychiatric diagnosis?

The problem we are faced with is that physicians seem to be FAR too quick to hand out the anti-psychotic medication, when a condition might be transiant, as in a brief psychotic episode, but dependency on anti-psychotics drugs can then set in, and within a few months, for those sensitive to its effects, it can do a lot of damage in a short amount of time -- the incidence of akithesia alone is remarkably high with the atypicals. And for what? Because someone had a brief psychotic break? That's shameful.

[bdeaner]

I didn’t realize that FR had become a Scientology haven.

I posted this article, and I am not a Scientologist. I have a doctorate in clinical psychology, and am a full time, tenured professor at a reputable university. Stop the ad hominem b.s. and stick to the facts. You can't discount the facts by aligning them with a crack-pot cult and still claim to be operating within the bounds of a reasoned argument. So bring it on.

Secondly, you have a misguided view of psychiatry history -- you've bought into the storyline of psychiatry and Big Pharma. There is another side of the story. You sound like one of those drug rep whores who work for Big Pharma. But let me set you straight.

Mental hospitals began to empty after 1955. New Jersey state hospitals, for example, held 15,000 patients then and only about 4000 today. This massive "decarceration" is widely credited to the success of the psychotropic drugs, but there is really no evidence for this. The rates of release from mental hospitals began to rise in the United States and England in the late 1940s and early 1950s, before the drugs were introduced. Prison release rates also began to rise shortly afterward. The trend toward decarceration in both kinds of institutions resulted from a recognition of the astronomical costs of the new hospitals and prisons that would be required without a reversal of the trend toward incarceration. The availability of drugs cannot explain the increased release rates in prisons, nor for the high release rates for patients with chronic brain syndromes who rarely were treated with drugs.

Let's look at the numbers, then. In 1955, there were 559,000 people in public mental hospitals, or 3.38 people per 1,000 population. In 2003, there were 5 .726 million people who received either an SSI or SSDI payment (or from both programs), and were either disabled by mental illness (SSDI statistics) or diagnosed as mentally ill (SSI statistics).' That is a disability rate of 19.69 people per 1,000 population, which is nearly six times what it was in 1955.

Those are the facts. The facts do not support the view that psychiatric medication caused the hospitals to empty. The patients just switched venues -- they became homeless, went to jail, or ended up in a group home somewhere with 24 hour supervision and a Thorazine shuffle.

[Lucius Cornelius Sulla]

I posted this article, and I am not a Scientologist.

I do not have your expertise, but the source of this article is a Scientology friendly website.

[bdeaner]

Broken hearted in Los Angeles...

God bless you, Polly, and your family, especially your son. Stories like yous keep me energized in my fight to alert people like you to the dangers of anti-psychotic medication, which continue to be minimized by psychiatry and the pharmaceutical industry. It's time for the lies to stop.

[bdeaner]

I do not have your expertise, but the source of this article is a Scientology friendly website.

Don't get mesmerized by the source of the article. Scientologist-friendly or not, the article is factually correct.

[Lucius Cornelius Sulla]

I have the same attitude towards Scientology on psychiatry as I do Muslims on religion or Communists on economics.

[bdeaner]

Evidence of Brain Chemistry Abnormalities in Bipolar Disorder

Your problem is that you're not reading the original research study. You rely upon some journalist to interpret the study -- who obviously doesn't know how to critically evaluate a study's validity.

First, the findings are correlational. Correlation does not imply causation. One of the first things you learn in an introductory stats class.. If you are implying a causal relationship between these brain differences and the symptoms of bipolar disorder, you've made an incorrect inference, and should study up on hypothetico-deductive logic.

Second, the sample size in this study is very small. Only 16 patients are compared to 16 non-patients. That's a woefully inadequate sample size for making any reasonable generalizations to the population of interest here.

But most importantly, and the huge gaping hole of a flaw in this study is this: ALL THE BIPOLAR PATIENTS WERE BEING MAINTAINED ON MOOD-STABILIZING DRUGS AND A BUNCH OF THEM WERE ON ANTI-PSYCHOTIC MEDICATION. Gee, do ya think that might account for the differences in their brain functions, in comparison to non-patient comparison who are NOT on these drugs? TALK ABOUT A HUGE FRIGGIN' CONFOUNDING VARIABLE!!! This is the most pointless study I've read in a long time. You can conclude NOTHING from this, and the study probably shouldn't have been published, because people like you are going around referencing it like it means something when it doesn't mean jack. Good lord.

See for yourself. Read the study, dude:

http://ajp.psychiatryonline.org/cgi/content/full/157/10/1619

[bdeaner]

I have the same attitude towards Scientology on psychiatry as I do Muslims on religion or Communists on economics.

The article was published in The Guardian, so it's legit. It stands up to a fact check, and I urge you to challenge it on this ground. It's not a Scientology fluff piece. I don't see any reference to Scientology anywhere on the site--but who knows. Still doesn't change the facts.

Second, hey I'm with you on communism, but maybe you should try not to be less proud of your bigotry toward Muslims. Last time I checked, my God told me to love my enemies. We Christians share a lineage with Islam that goes back to Abraham. And if you read Genesis, which I suggest you do, God blessed Ishmael and promised him a great nation -- the nation that became Islam. So, it's not so clear cut.

[Lucius Cornelius Sulla]

maybe you should try not to be less proud of your bigotry toward Muslims.

9/11 taught me all I need to know about Islam.

[Lucius Cornelius Sulla]

maybe you should try not to be less proud of your bigotry toward Muslims.

9/11 taught me all I need to know about Islam.

[bdeaner]

9/11 taught me all I need to know about Islam.

That's like saying the Spanish Inquisition taught you all you need to know about Christianity.

I suspect your psychology is not that different from the guys who rammed those planes into the towers on that day. It's ultimately about hate -- a willingness to de-humanize a whole class of people and to take pride in ignorance.

[bdeaner]

,b>Luke 6:27-36

[27] "But I tell you who hear me: Love your enemies, do good to those who hate you, [28] bless those who curse you, pray for those who mistreat you. [29] If someone strikes you on one cheek, turn to him the other also. If someone takes your cloak, do not stop him from taking your tunic. [30] Give to everyone who asks you, and if anyone takes what belongs to you, do not demand it back. [31] Do to others as you would have them do to you.

[32] "If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. [33] And if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. [34] And if you lend to those from whom you expect repayment, what credit is that to you? Even 'sinners' lend to 'sinners,' expecting to be repaid in full. [35] But love your enemies, do good to them, and lend to them without expecting to get anything back. Then your reward will be great, and you will be sons of the Most High, because he is kind to the ungrateful and wicked. [36] Be merciful, just as your Father is merciful.

[bdeaner]

The Arabs are descents of Ishmael, who is described in the Old Testament:

Ishmael, meaning God hears, was the son of Abraham and Hagar, the Egyptian maid of his wife Sarah. When Sarah had found herself not having children, she arranged to have a child with Abraham by Hagar acting as a surrogate mother (Genesis 16:1-4), even though God had specifically stated that a child (i.e. Isaac) would be born to Sarah in due time.

Ishmael was born at Mamre, when Abraham was 86, 11 years after Abraham's arrival in what would become the land of Israel (Genesis 16:3). He grew up to be a man of the desert wilderness, with a wild and hostile attitude toward people, exactly as God described him to his mother before he was born:

"Behold, you are with child, and shall bear a son; you shall call his name Ishmael; because The Lord has given heed to your affliction. He shall be a wild ass of a man, his hand against every man and every man's hand against him; and he shall dwell over against all his kinsmen." (Genesis 16:11-12 RSV).

When a feast was held to celebrate the weaning of Isaac, who was born 13 years later, Ishmael caused trouble by insulting and mocking his little brother (Genesis 21:8-9). After Sarah, who by then had come to dislike both Hagar and Ishmael, saw what he was doing, she said to Abraham "Cast out this slave woman with her son; for the son of this slave woman shall not be heir with my son Isaac." (Genesis 21:10 RSV)

Abraham opposed Sarah's demand - despite Ishmael's difficult personality, Abraham loved him and did not want to see him go. God however settled the matter:

"But God said to Abraham, "Be not displeased because of the lad and because of your slave woman; whatever Sarah says to you, do as she tells you, for through Isaac shall your descendants be named. And I will make a nation of the son of the slave woman also, because he is your offspring." (Genesis 21:12-13 RSV)

Hagar and Ishmael were sent away, but they were not abandoned. God appeared and spoke to Hagar, assuring her that He would watch over them and see them prosper (Genesis 21:17-19). "And God was with the lad, and he grew up; he lived in the wilderness, and became an expert with the bow. He lived in the wilderness of Paran; and his mother took a wife for him from the land of Egypt" (Genesis 21:20-21 RSV).

Interpretation: Islam is the result of Abraham's sin. He did not have faith in God, but was inpatient, and slept with Sarah's slave woman, fearing that Sara could not become pregnant, as the Lord predicted. We reap what we sow. Salvation history demands that we resolve things with Islam peacefully, or else we make God a liar, for He promised Islam a place at the table. What are we Christians to do with that little problem? Not an easy one, and it is all too convenient to hate Islam because then that gives the appearance of resolving the problem -- yet the problem remains -- and will remain, until the Lord works out His salvation History according to His plan. I have faith He will not lead us astray, if we have faith in Him.

Of course, this is completely unrelated to this thread and probably belongs in another forum, but nevertheless...there it is.

[Lucius Cornelius Sulla]

There are few, if any active Muslims willing to denounce the 9/11 attacks. On that day I pledged my life to doing what I could to exterminate all of those who took part in this attack, or gave their approval, even their silent approval. I still have a lot of murdering to do to accomplish this goal. If I ever finish I will get back to you.

[gusopol3]

. See : The Things I Learned in Kindergarten, as well as the appendix And Forgot When I got My Doctorate.

[bdeaner]

I know a lot of Muslims, personally, who denounce the attacks. One of them is a guy who set me up with my wife for our first blind date. He knew I was Christian at that time, and hey I’m still alive. Why would he want us Christians to propagate, according to your logic?

[Admin Moderator]

C’mon, you can have a spirited debate without resorting to the name-calling.

[bdeaner]

Come out of the cloisterd hallways of sterile academia and experience real life, so as not to appear as you do, a lying buffoon.

You know you're losing an argument when you need to resort to baseless ad hominem attacks. By the way, I'm not just an ivory tower academic. I work with clients in the real world, thank you. My concerns grow precisely out of clinical work with real people and what I am seeing happening in the field. I've consulted with many other clinicians on this, and while not all agree with my opinions, the majority I've consulted with share my concerns.

Second, as has been discussed with you before, you're wrong to think that anti-psychotics are limited only to those patients who absolutely need them, after all other options have been exhausted. The stuff is being handed out like candy now to kids and the aged even when no serious, in-depth psychological assessment has been completed, with minimum intake interview, and even when it is contra-indicated due to side effects.

The $1.4 Billion fine paid by Eli Lilly illustrates the point clearly. The pharmaceutical companies are marketing the drugs off-label, for conditions that they were not meant to treat, and in some cases, where the side effects are far worse than the symptoms for which the drugs are used to treat. Nausea being a case in point. Many physicians are obliging the drug companies, whose reps continue to minimize the side effects. This is serious enough that many states filed suit against Lilly, and they are now paying the largest fine, for CRIMINAL CONDUCT, ever paid by a pharmaceutical company. And I am the one minimizing things? Yeah, right.

[Zevonismymuse]

I hate these meds...

Your story breaks my heart. There is a time and place for Haldol in the short term management of dangerous psychotic behavior but I do not think it should be used on a long term basis and it should never be used to manage what might be called annoying behavior, especially in the very young and the very old whose cells are so fragile. My sincerest condolences.

[Zevonismymuse]

Again the illnesses are serious and your attempts to minimize them are tragic and misguided.

I did not get the sense bdeaner was minimizing the seriousness of schizophrenia and other mental illness. I just think that our industrial approach to treating the disease is not working by any measure. bdeaner was providing some historical accounts of a more humane approach to treating the mentally ill. I worked in locked psych for a number of years and while the patients had very obvious psychotic symptoms these people were able to respond to behavioral therapies especially when the environment was peaceful. The character of the people working with the patients was also key but unfortunately there were some angry cruel people working on every ward. Sadly about a third of the patients in locked psych wards are so mentally ill that no therapy works and they must be chemically restrained for the safety of society, but this must be considered as an absolute last resort.

[agrace]

With regard to overuse - the problem as this lay person sees it is that these days, GPs are diagnosing and treating with these drugs with the encouragement of pharamceutical marketing, and psychiatrists are overprescribing all psychotropics (it seems to me that many don’t seem to do much therapy these days, opting instead for drugs as first choice treatment for just about everything).

I can understand use of these in the most severe cases (such as the one you cite), but should someone diagnosed (misdiagnosed, as it turned out) with a lesser mental illness such as bipolar 2 be given a cocktail of antidepressants and anti-psychotics?

I have personal experience with watching someone go from somewhat anxious (enough to warrant a dr visit) to severely anxious, agitated and paranoid (after the introduction of ADs), to downright psychotic and completely disfunctional (after the introduction of antipsychotics).

Here was the progression - zoloft = agitation and insomnia —> wellbutrin = agitation, insomnia, anxiety attacks, racing thoughts, akathisia, paranoia, desperate thoughts —> diagnosis of BP2 + effexor = psychotic reaction + alarmed GP —> lesser effexor dose + risperdal + referral to psychiatrist —> cymbalta + wellbutrin + seroquel = passed out zombie —> cymbalta + wellbutrin + lamictal = increasing neuro effects + job loss —> cymbalta + wellbutrin + depakote = daily neuro effects + mild nightly psychosis —> cymbalta + wellbutrin + the suggestion of lithium, but upon balking of the patient, return to seroquel —> rejection of psychiatric advice, slow weaning off all drugs, second opinion and rejection of initial diagnosis = drug free and happier for it one year later.

I’m sure that sounds crazy, but every word is true, and as a result of my desperate studies on all involved I have to ask, how many low level patients who should just be in therapy to deal with life issues (in this case, the unexpected sudden death of his mother due to a massive stroke combined with a family move and a high pressure sales job) are put on drugs that do nothing but harm them in the long run?

I’m thanking God every day that our experiences were short-lived, because articles such as this one - knowing that these kinds of drugs are the most prescribed class in America today, knowing that at least 10% of the entire US population is on psychotropics of some kind, knowing that these drugs are often prescribed for off-label use for things such as bipolar 2, chronic pain, and incontinence, for Pete’s sake - are downright frightening.

(This article deals with anti-psychotics, but studies on the effects of messing with seratonin levels are just as alarming.)

In severe cases are they a good idea? Sure, maybe. In such a large percentage of the general population? Not on your life. Or should I say, not on their lives.

[Zevonismymuse]

Now most of these people are functioning in society, and the mental hospital population is a fraction of what it was.

Well you are half right; the mental hospital population is down but I don't think I agree that most of these people are functioning in society. Where I live they live under bushes and hang out on State Street accosting tourists.