Antipsychotics

In November, Joanna Moncrieff, MD, a British psychiatrist who works as a Senior Lecturer in psychiatry at University College London and a practicing consultant psychiatrist, started her own blog. What’s remarkable about this blog is that it is highly critical of psychiatry. Dr. Moncrieff marshals important facts and arguments in this area, and it is probably safe to say that her popularity among her peers is in decline. The facts that she adduces, however, are indisputable, and her qualities of honesty, courage, and integrity are evident in everything she writes. ...

BACKGROUND On December 8, I received the following question from a reader: (The subject matter is the controversial CAFÉ – Comparisons of Atypicals in First Episode of Psychosis - study. This was the study in which Dan Markingson committed suicide.) "It appears that there was no head-to-head with a control group taking a placebo pill. Nor was there a control group featuring 'old' types of 'antipsychotic'. If that was the case then it is very poor study. If you are just looking at 3 'new' subtypes of a 'new' class - then what on earth can you hope to show from the data." ...

In December 2012, Mark Olfson, MD, et al, published an article in the Archives of General Psychiatry. The title is National Trends in the Office-Based Treatment of Children, Adolescents, and Adults with Antipsychotics. The authors collected data from the National Ambulatory Medical Care Surveys for the period 1993-2009, and looked for trends in antipsychotic prescribing for children, adolescents, and adults in outpatient visits. Here are the results: Age Increase in no. of antipsychotic prescriptions per 100 population (1993-2009) 0-13 0.24-1.83 (almost 8-fold) 14-20 0.78-3.76 (almost 5-fold) 21+ 3.25-6.18 (almost 2-fold)   The authors provide a breakdown of the diagnoses assigned to the children and adolescents during the antipsychotic visits. ...

Earlier this year, The American Society of Consultant Pharmacists published a report on the use of neuroleptic drugs in nursing homes. According to this report, 25% of nursing home residents receive neuroleptic drugs. In general, the Centers for Medicare and Medicaid Services (CMS) consider these prescriptions appropriate only if the recipient is psychotic. (Obviously we could discuss this at length, but let’s set that issue aside for now.) What CMS considers entirely inappropriate, however, is prescribing these products to residents with dementia as a way of controlling “difficult” behaviors such as wandering, being abusive, or resisting care. ...