Friday, January 29, 2016
Medications, Parrots, and Crazy Virginia Laws
For today's post, I'd like to send you around the web.
First, Pete Earley has a piece up by Robert Whitaker of Mad in America. Whitaker clarifies his position on antipsychotic medications and how their use should be avoided or minimized in Robert Whitaker Explains his Research after being Pigeon-holed as Anti-Medication. Let me add my bias: I didn't like Whitaker's book Anatomy of an Epidemic where he concluded that anti-psychotics cause psychiatric disability. His point was correlational -- as anti-psychotic use went up, so did SSDI (government disability) claims. It's not that easy -- there are other factors that contribute to disability claims including financial & social incentives and the acceptability of being on SSDI. After you read the post on Pete's blog, I'd like to make two points:
~I don't think that it's controversial that people should be on the lowest possible dose of medications --any medications. Unfortunately, in psychiatry, we figure out the lowest dose by dropping the medications until someone gets sick. It's not benign, with each small drop in dose there is some risk that a person will end up psychotic, in the hospital, or unable to function, and recovery can take months or more. So when someone is doing well, working and involved in meaningful relationships, it's not a low risk issue to drop medications. If they are having side effects, it's a lot easier to take this risk, because at least you're addressing a problem. This stuff is not easy when you're talking about real people.
~I remember life before the second generation antipsychotics. Patients hated taking Haldol and Prolixin and Mellaril and Stelazine. They were very articulate about how miserable the side effects were, and I don't recall anyone saying that patients wouldn't take Haldol because they had "anosognosia" (ah, we didn't have that word then). Psychiatrists were well aware that patients didn't take the medications because they made them feel like molasses had been poured into the crevices of their brains, or worse. Second generation antipsychotics may be no more effective, but they are more acceptable to many patients.
Having said all that, Whitaker may be right that people do better with less medicine, either because those who aren't as sick don't need as much medicine and may be able to completely stop, or because the medications sensitize people and make them worse (I have no answers here.) When someone is psychotic and suffering, this isn't all that helpful. I wish we had better answers. Whitaker, and others point to Open Dialogue as a panacea, and it may be a better way with better results -- not much of it is controversial, just expensive and it requires resources for immediate response that we don't seem to have in this country. There are 5.5 million people in Finland and 321 million people in the US, so the issues are different, and people in Finland get hospitalized and disabled, too.
While I'm pointing you around, Alex Langford does a nice job of discussing Open Dialogue with all it's pros and cons on his blog Here. Well worth the read.
You've heard of Creigh Deeds? He's a Virginia state senator whose very ill and very dangerous son was released from an ER because of a quirk of Virginia state law that said if a bed could not be found within 6 hours, then a patient must be released. Tragedy ensued -- Gus Deeds repeatedly stabbed his father and then died of suicide. Over on Clinical Psychiatry News, I explain the idiosyncrasies of Virginia law that could allow such horrors to happen. See Understanding the Deeds Family Tragedy.
And for the latest news in schizophrenia research, here's a study in Nature that's making headlines everywhere. If I could understand it, I'd explain it to you. Maybe Roy could drop by for this one? We haven't seen him for a bit.
Lastly, I'll include a link to an article about PTSD and parrots. ClinkShrink likes birds, and she loves parrot jokes, so please do share yours. What Does a Parrot Know About PTSD?
Posted by Dinah on Friday, January 29, 2016