Neuroleptics

On August 19, 2014, the Annals of Internal Medicine published a paper titled Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury [AKI] and Other Adverse Outcomes in Older Adults. The authors were Joseph Hwang et al, and the study was conducted at the Institute for Clinical Evaluative Sciences in Ontario, Canada. The primary funding source was the Academic Medical Organization of Southwestern Ontario. The principal investigator was Amit X. Garg, MD, PhD, a kidney specialist at the London Health Science Center and the London Kidney Clinical Research Unit in Ontario, Canada. ...

On July 17, I wrote a post on the use of neuroleptic drugs as chemical restraints in nursing homes. The article generated some comments, one of which touched on some very fundamental issues which, in my view, warrant further discussion. The comment was from drsusanmolchan and read as follows: "All drugs can be dangerous toxic chemicals when not used appropriately. While many valid points are made in this article, it’s very one-sided and could be considered biased in that it’s written by a psychologist. I’ve seen many patients and families benefit from their use. ...

There’s an interesting article in the July-August 2014 issue of the AARP Bulletin. It’s called Drug Abuse: Antipsychotics in Nursing Homes, and was written by Jan Goodwin. AARP is the American Association of Retired Persons. Jan Goodwin is an investigative journalist whose career, according to Wikipedia, “…has been committed to focusing attention on social justice and human rights…” The article is essentially a condemnation of the widespread and long-standing practice of using neuroleptic drugs to suppress “difficult” behavior in nursing home residents. ...

On March 27, the US House of Representatives approved by a voice vote with no debate a Medicare bill, HR 4302, Protecting Access to Medicare Act of 2014. The purpose of the bill is to avoid cutting Medicare payments to physicians, and there was, and is, general agreement on both side of the aisle that the bill needed to pass. However, tacked onto the bill was a rider which authorized $60 million to expand involuntary outpatient commitment (IOC) in states that already have provision for commitments of this sort. ...

The recent publicity surrounding the Justina Pelletier case has focused attention, not only on the spurious and arbitrary nature of psychiatric diagnoses, but also on the legitimacy and appropriateness of mental health commitments. It is being widely asserted that these archaic statutes are fundamentally incompatible with current civil rights standards, and the question “should mental health commitments be abolished?” is being raised in a variety of contexts. CRITERIA ...

There’s an interesting February 11, 2014, article on Peter Breggin’s website: $1.5 Million Award in Child Tardive Dyskinesia Malpractice. Thanks to Mad in America for the link. Here’s the opening paragraph: "On February 11, 2014 a Chicago jury awarded $1.5 million to an autistic child who developed a severe case of tardive dyskinesia and tardive akathisia while being treated by psychiatrists with Risperdal and then Zyprexa between 2002 and 2007. The drug-induced disorder was diagnosed when he was fifteen years old and by then had become disabling and irreversible." ...

I recently read The NIMH-CATIE Schizophrenia Study: What Did We Learn? by Jeffrey Lieberman, MD, and T. Scott Stroup, MD, MPH. The article was published in the American Journal of Psychiatry 168:8, August 2011. Here are two quotes: "When the CATIE study was designed in 1999-2000, the prevailing opinion of researchers and clinicians alike was that the newer (second-generation) antipsychotic drugs were vastly superior to the older (first-generation) antipsychotic drugs in efficacy and safety. This largely reflected the results of studies sponsored by the manufacturers of the new drugs…, marketing messages of pharmaceutical companies and the hopes of many who wanted better treatments." ...

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. ...