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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by linkadge on June 7, 2005, at 20:26:44
In reply to Re: This shocked me !!, posted by Jakeman on June 7, 2005, at 20:19:12
I have read in a number of places (not just this article) that nash used no medications after 1970.
I am sure he must have tried them to conclude that the newer ones can still have side effects, but I am assuming he didn't stick with them.
The movie portrays him as quickly relapsing after any attempt to stop meds, this is simply not true.
Linkadge
Posted by fires on June 7, 2005, at 21:17:50
In reply to This shocked me !!, posted by linkadge on June 7, 2005, at 18:18:21
" has brought welcome attention to the fact that people can and do recover from schizophrenia"
Sounds like something Tom Cruise and his Scientology friends would dream up.
Where does it state that Nash "recovered" from schizophrenia? Maybe he improved with age (lower functioning immune system?), but I've never heard that he recovered.
Thanks
Posted by Larry Hoover on June 7, 2005, at 22:00:09
In reply to This shocked me !!, posted by linkadge on June 7, 2005, at 18:18:21
> Most Americans are unaware that the World Health Organization (WHO) has repeatedly found that long-term schizophrenia outcomes are much worse in the USA and other "developed" countries than in poor ones such as India and Nigeria, where relatively few patients are on antipsychotic medications. In "undeveloped" countries, nearly two-thirds of schizophrenia patients are doing fairly well five years after initial diagnosis; about 40% have basically recovered. But in the USA and other developed countries, most patients become chronically ill. The outcome differences are so marked that WHO concluded that living in a developed country is a "strong predictor" that a patient never will fully recover.
I dunno about that. There are many myths related to medication, and the disorder that underlies it. To what do we attribute the lack of recovery? Maybe it is American society that so stigmatizes these individuals that their recovery is not possible. That is nothing to do with the illness, or the meds.
One issue that I bet everybody is clear on is that neuroleptics cause dyskinesia. Right?
Maybe. From the look of these two studies, maybe at the worst, they might bring it on sooner in susceptible individuals (that's my own interpretation of the full-text articles). But the incidence is the same, in a life-span perspective, when comparing neuroleptic-treated and untreated schizophrenics.
Lar
Br J Psychiatry. 1996 Feb;168(2):221-6.
Abnormal movements in never-medicated Indian patients with schizophrenia.
McCreadie RG, Thara R, Kamath S, Padmavathy R, Latha S, Mathrubootham N, Menon MS.
Clinical Research, Crichton Royal Hospital, Dumfries.
BACKGROUND: Historical records suggest dyskinesia was observed in severely ill institutionalised patients with schizophrenia in the pre-neuroleptic era. More recent work has not found dyskinesia in never-medicated younger and middle aged patients. The present study complements this recent work and avoids the confounders of severity of illness and institutionalism by examining elderly patients in a wide variety of community settings. METHOD: Movement disorders were examined in 308 elderly individuals in Madras, India, using the Abnormal Involuntary Movements Scale, the Simpson and Angus Parkinsonism Scale and the Barnes Akathisia Scale. Patients' mental state was assessed by the Positive and Negative Syndrome Scale. RESULTS: Dyskinesia was found in 15% of normal subjects (n = 101, mean age 63 years), 15% of first degree blood relatives of younger schizophrenic patients (n = 103, mean age 63 years), 38% of never medicated patients (n = 21, mean age 65 years) and 41% of medicated patients (n = 83, mean age 57 years). The respective prevalences for Parkinsonism were 6%, 11%, 24% and 36%; and for akathisia 9%, 5%, 21% and 23%. Dyskinesia was associated with negative schizophrenic symptoms. CONCLUSIONS: Dyskinesia in elderly schizophrenic patients is an integral part of the illness and not associated with antipsychotic medication.
J Clin Psychiatry. 2000;61 Suppl 4:10-4.Prevalence of spontaneous dyskinesia in schizophrenia.
Fenton WS.
Chestnut Lodge Hospital, Rockville, MD 20850, USA. WSFMD@AOL.COM
Spontaneous abnormal involuntary movements phenomenologically identical to neuroleptic-induced tardive dyskinesia have been described in schizophrenia for over a century. Because at present nearly all patients with schizophrenia are exposed to neuroleptic medications, information about the prevalence of spontaneous dyskinesia is obtained from accounts from the preneuroleptic era, evaluations of first-episode patients before neuroleptic treatment, and the identification and assessment of drug-naive patients in developing countries. In this report, data from 14 studies of neuroleptic-naive patients with schizophrenia are used to generate age-adjusted estimates of the prevalence of spontaneous dyskinesia. While the precision of this estimate is limited by the difficulty of obtaining large, untreated samples, available data suggest a spontaneous dyskinesia rate of approximately 4% in first-episode schizophrenic patients, 12% for patients ill several years but below age 30 years, 25% for those aged between 30 and 50 years, and 40% for those aged 60 years or older. Relative to the incidence and accrued prevalence of spontaneous dyskinesia expected during the natural history of untreated schizophrenia, the cumulative impact of treatment with new neuroleptic agents has yet to be determined.
Posted by Phillipa on June 7, 2005, at 22:09:31
In reply to Re: This shocked me !! » linkadge, posted by Larry Hoover on June 7, 2005, at 22:00:09
Could it be he was misdiagnosed? I know a lot of times Bipolar illness used to be diagnosed as schizophrenia. And many bipolars can go years without a relapse. It happened to my exfatherinlaw. He had one episode in his 20's than amassed a fortune and relapsed in his late 50's due to very high stress from all his business ventures. Fondly, Phillipa
Posted by Racer on June 7, 2005, at 22:55:33
In reply to Re: This shocked me !!, posted by linkadge on June 7, 2005, at 20:26:44
First of all, who made the diagnoses in the third world countries? Are they using the same definition? Remember: most mental illnesses are diagnosed based on clinical signs -- which means that there are some rather arbitrary diagnoses made at times. How can you tell the difference, say, between schizophrenia and bipolar with psychosis? (Thank you, Phillipa, for pointing that one out.) Or between one of the slightly psychotic looking personality disorders? If you're getting a diagnosis from a doctor who comes to your local, rural clinic once every three months -- which, to be fair, happens in this country, too, in areas -- how carefully can he delve into your symptomology?
When you discuss recovery, there are similar questions to be asked, too: what do you mean by recovery? Does that mean that you've learned to accommodate your disorder? That your family has made adjustments that allow you to stay safe? Or does it mean what most of us would consider it to mean?
There's another issue, too: social support systems. In many "developing" countries, there are stronger extended family groups who can provide support. Don't even think that that doesn't make a difference! My guess is it counts more than drugs or no drugs in any outcomes. Wouldn't it be a lot easier for us to function if we had a family group that worked together to make sure that we had things like food, a roof, etc?
So, maybe John Nash really did recover without drugs. Maybe he took drugs now and again, when his symptoms got really out of hand. Maybe anti-psychotics are the worst thing since Red Dye #3. I don't know.
What I do know, though, is that any OP-ED piece like that -- *especially* in USA Today -- is less informational, and more propagandal.
Posted by SLS on June 8, 2005, at 6:42:38
In reply to A couple of things to keep in mind..., posted by Racer on June 7, 2005, at 22:55:33
At the very least, de facto, Nash was not ill enough to be so psychotic as to be incompetent to live independantly. Lots of people who have a schizoid disorder can manage their symptoms if the symptoms are mild enough. Nash chose to remain delusional and fight his delusions every day without medication. I probably would have chosen a different path if one were available. Now they do. There is no longer a need to fight every day because, for many people, modern medication works to make the delusions and hallucinations disappear completely. I've seen it up close and personal. For me, this is not just an academic exercise to debate the issue. It is real life.
- Scott
Posted by alienatari on June 8, 2005, at 8:58:29
In reply to This shocked me !!, posted by linkadge on June 7, 2005, at 18:18:21
I remember reading about John Nash's story when I was studying Abnormal Psychology and how he recovered without AP's. It truely is amazing.
> The following article shocked me.
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> -------------------------------------------------
> John Nash: Recovery Without Drugs
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> One of this year's keynoter's at the November 21-24 annual conference in Portland of the National Association of Rights Protection Advocacy (NARPA) is noted author Robert Whitaker. Following is a OP ED piece he wrote recently for USA Today. Below that is a public statement by psychologist and author Barry Duncan, PhD about this falsehood in "A Beautiful Mind," and its implications.
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> Mind drugs may hinder recovery
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> by Robert Whitaker
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> USA Today Forum March 4, 2002
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> The movie A Beautiful Mind, nominated for eight Academy Awards, has brought welcome attention to the fact that people can and do recover from schizophrenia, a severely disabling disorder that affects about one in 100 Americans. Unfortunately, the film fabricates a critical detail of John Nash's recovery and in so doing, obscures a question that should concern us all: Do the medications we use to treat schizophrenia promote long-term recovery -- or hinder it?
>
> In the movie, Nash -- just before he receives a Nobel Prize -- speaks of taking "newer medications." The National Alliance for the Mentally Ill has praised the film's director, Ron Howard, for showing the "vital role of medication" in Nash's recovery. But as Sylvia Nasar notes in her biography of Nash, on which the movie is loosely based, this brilliant mathematician stopped taking antipsychotic drugs in 1970 and slowly recovered over two decades. Nasar concluded that Nash's refusal to take drugs "may have been fortunate" because their deleterious effects "would have made his gentle re-entry into the world of mathematics a near impossibility."
>
> His is just one of many such cases. Most Americans are unaware that the World Health Organization (WHO) has repeatedly found that long-term schizophrenia outcomes are much worse in the USA and other "developed" countries than in poor ones such as India and Nigeria, where relatively few patients are on antipsychotic medications. In "undeveloped" countries, nearly two-thirds of schizophrenia patients are doing fairly well five years after initial diagnosis; about 40% have basically recovered. But in the USA and other developed countries, most patients become chronically ill. The outcome differences are so marked that WHO concluded that living in a developed country is a "strong predictor" that a patient never will fully recover.
>
> Myth of medication
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> There is more. In 1987, psychologist Courtenay Harding reported that a third of chronic schizophrenia patients released from Vermont State Hospital in the late 1950s completely recovered. Everyone in this "best-outcomes" group shared one common factor: All had weaned themselves from antipsychotic medications. The notion that schizophrenics must spend a lifetime on these drugs, she concluded, is a "myth."
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> In 1994, Harvard Medical School researchers found that outcomes for U.S. schizophrenia patients had worsened during the past 20 years and were now no better than they were 100 years earlier, when therapy involved plunking patients into bathtubs for hours. And in 1998, University of Pennsylvania investigators reported that standard antipsychotic medications cause a specific area of the brain to become abnormally enlarged and that this drug-induced enlargement is associated with a worsening of symptoms.
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> Comprehensive care succeeds
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> All of this has led a few European physicians to explore non-drug alternatives. In Finland, doctors treat newly diagnosed schizophrenia patients with comprehensive care: counseling, social-support services and the selective use of antipsychotic medications. Some patients do better on low doses of medication, and some without it. And they report great results: A majority of patients remain free of psychotic symptoms for extended periods and hold down jobs.
>
> John Nash's recovery from schizophrenia is a moving story. But we are not well served when the movie fibs about the antipsychotic drugs' role in his recovery. If anything, his story should inspire us to reconsider anti-psychotics' long-term efficacy with an honest, open mind. That would be a first step toward reforming our care -- and if there is one thing we can conclude from the WHO studies, it is that reform is vitally needed. Perhaps then we could even hope that schizophrenia outcomes in this country would improve to the point that they were equal to those in poor countries such as India and Nigeria.
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> Robert Whitaker is the author of Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill.
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> Source: USA Today archives
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Posted by linkadge on June 8, 2005, at 15:02:44
In reply to Re: This shocked me !!, posted by alienatari on June 8, 2005, at 8:58:29
I read in another location, that Nash said he would not have been able to come up with the work he did, had he taken the medication consistantly.This statement I fully believe. Although, I am not schitsophrenic, I am in math, and I have seen my grades drop from high, to barely passing when I took zyprexa.
Linkadge
Posted by Larry Hoover on June 8, 2005, at 15:26:51
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 15:02:44
>
> I read in another location, that Nash said he would not have been able to come up with the work he did, had he taken the medication consistantly.
>
> This statement I fully believe. Although, I am not schitsophrenic, I am in math, and I have seen my grades drop from high, to barely passing when I took zyprexa.
>
>
> LinkadgeHey link, have you ever read the Starson case file? Some calling him one of today's greatest theoretical physicists, he's held in a mental institution because he refuses treatment. It went to the Supreme Court of Canada. It's an interesting read, if you like reading court decisions.
http://www.lexum.umontreal.ca/csc-scc/en/pub/2003/vol1/html/2003scr1_0722.html
The Ontario court ruling is much shorter:
http://www.cognitiveliberty.org/neuro/Starson.htmlLar
Posted by linkadge on June 8, 2005, at 20:09:22
In reply to Re: This shocked me !! » linkadge, posted by Larry Hoover on June 8, 2005, at 15:26:51
I think that it is good in some ways that these things happen. Not that these people have to be sick, but that these people believe in themselves enough to know what is acceptable.
It really forces us all to look at the standards we have. It sends a screaming message to the drug companies. "Your drugs are inadequate"
Not we, can't all be John Nash, but that doesn't mean we don't diserve to be treated well without side effects that ruin the very essence of who we are.
The drug companies can get away with a lot of statements about how their drugs don't affect cognition etc. But when one of these super-geniouses says that they do, we all listen.
I think that we all diserve a lot more.
Linkadge
Posted by linkadge on June 8, 2005, at 20:17:00
In reply to Re: This shocked me !! » linkadge, posted by Larry Hoover on June 8, 2005, at 15:26:51
Like, quite honestly I think the quality of life of those suffering from depression is no better today than it was 10 years ago.
I mean prozac still is today probably one of your best bets, as it was back in the late 80's.
I was reading the book, "Drugs and the Brain" by Solomon H. Snyder, 1986. In this book they discribe citalopram and its usefullness in treating depression. But this drug doesn't see the light of day till like 14 years later. The reason it takes a drug that has been proven effective 14 years to make it onto the market astounds me.
I mean wasn't RU-486 supposed to be in a fast-tracking process? Theres a lot of hype but still a lot of suffering.
Linkadge
Posted by linkadge on June 8, 2005, at 20:39:11
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 20:17:00
Again, I am no john Nash, but it has got to the point where my ability to continue in school is going to be compromised by adequate treatment.
No treatment, I do well, but I want to kill myself every day. Treatment, I feel better, but I am a zombie, and quickly become depressed at the prospects of not being able to complete what I have started.
It is discouraging, and doctors don't seem to see the whole picture.I still get asked dumb things like, "you do well in school, what are you depressed about ??"
I don't know why I want to kill myself, I just do. It is as simple as that. I've just had it with doctors and 8 minaute appointments, and the situation just doesn't seem to be getting any better.
Doctors keep asking me why I stop my medication, and I tell them things like: "I have a life to live". You guys think you're so smart cause you can modify one little aspect of human emotion, but hey, we don't need to pay any attnetion to the fact that you will indeed become a druling vegetable.
To me 99% of ssri effect is just a lot of fluf.
Linkadge
Posted by fires on June 8, 2005, at 20:49:38
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 20:09:22
> It really forces us all to look at the standards we have. It sends a screaming message to the drug companies. "Your drugs are inadequate"
>
<snip>
> LinkadgeThey know that current meds are inadequate. They don't need to be sent a screaming message.
Sertraline clinical tial participant/dropout, 1988.
Posted by fires on June 8, 2005, at 20:51:58
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 20:17:00
> I mean prozac still is today probably one of your best bets, as it was back in the late 80's.SSRIs are darn near "poison" for some of us! Effexor and Cymbalta have been big breakthrough meds for some.
Posted by linkadge on June 8, 2005, at 21:11:41
In reply to Re: This shocked me !! » linkadge, posted by fires on June 8, 2005, at 20:49:38
Nothing that couldn't have been done with a prozac nortryptaline combination.
Ok, so lets suppose the drug companies do know that their drugs are inadequate, they still seem unwilling to take a step outside the box and try something creative. They sure don't give the public the accurate message of their effectivness.
You don't see adverisements like
"prozac, non-statistically better than placebo in one out of 9 trials!"
"prozac, a one in 9 chance, you'll feel slightly better than if you took a sugar pill"
I mean there are drugs out there, effective antideperessants, that because of small abuse potential, will never be released. They are still fixed on the idea that an antideperessant must not produce happiness in normal controlls.As far as antipsychotics go, lilly probably does't give two hoots about schitsophrenia, they're just glad that their product has such a market for SSRi induced insomnia.
Linkadge
Posted by linkadge on June 8, 2005, at 21:12:52
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 21:11:41
Its the non psychotic people on the antipsychotics, and the really psychotic people are sane enough to realize the dammage that they do!
Linkadge
Posted by jay on June 8, 2005, at 21:15:04
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 20:39:11
> Again, I am no john Nash, but it has got to the point where my ability to continue in school is going to be compromised by adequate treatment.
>
> No treatment, I do well, but I want to kill myself every day. Treatment, I feel better, but I am a zombie, and quickly become depressed at the prospects of not being able to complete what I have started.
>
>
>
>
> It is discouraging, and doctors don't seem to see the whole picture.
>
> I still get asked dumb things like, "you do well in school, what are you depressed about ??"
>
> I don't know why I want to kill myself, I just do. It is as simple as that. I've just had it with doctors and 8 minaute appointments, and the situation just doesn't seem to be getting any better.
>
> Doctors keep asking me why I stop my medication, and I tell them things like: "I have a life to live". You guys think you're so smart cause you can modify one little aspect of human emotion, but hey, we don't need to pay any attnetion to the fact that you will indeed become a druling vegetable.
>
> To me 99% of ssri effect is just a lot of fluf.
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>
>
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> Linkadge
>Linkadge, I got 90 percent in a Graduate level social research course. It involved qualatative and quantatative (mostly math, stats, number crunching) research, and I am (and was) on a big mix of a.d's, a.p.'s, etc. The other thing is, I am usually *horrible* with math, hate numbers, and after 10 or so years of heavy medication, did very well in this course. This was at the University of Toronto, the biggest in Canada. I knew many fellow students who where on medication doing Grad work too, all very well. (You *had* to be good at the U of T, or else they would boot you out!!!..mental illness or not.) Sorry, but I do not, for one minute, believe medication prevents a person from doing good school work.
Jay
Posted by fires on June 8, 2005, at 21:22:42
In reply to Re: This shocked me !!, posted by linkadge on June 8, 2005, at 21:11:41
> Nothing that couldn't have been done with a prozac nortryptaline combination.
You are forgetting something about the TCAs: "Patients with cardiovascular disease should be given nortriptyline only under close supervision because of the tendency of the drug to produce sinus tachycardia and to prolong the conduction time. Myocardial infarction, arrhythmia, and strokes have occurred."
>
> Ok, so lets suppose the drug companies do know that their drugs are inadequate, they still seem unwilling to take a step outside the box and try something creative. They sure don't give the public the accurate message of their effectivness.
>
> You don't see adverisements like
>
> "prozac, non-statistically better than placebo in one out of 9 trials!"
>
> "prozac, a one in 9 chance, you'll feel slightly better than if you took a sugar pill"The stats you quote are new to me. Source?
> I mean there are drugs out there, effective antideperessants, that because of small abuse potential, will never be released.For example?
>> They are still fixed on the idea that an antideperessant must not produce happiness in normal controlls.
>
> As far as antipsychotics go, lilly probably does't give two hoots about schitsophrenia, they're just glad that their product has such a market for SSRi induced insomnia.
>
>
>
> Linkadge
Posted by linkadge on June 8, 2005, at 21:35:01
In reply to Re: This shocked me !! School.. » linkadge, posted by jay on June 8, 2005, at 21:15:04
Well, Jay, I am not saying that some people don't do well. Perhaps you can function quite normally without the activation of your frontal cortex d2 receptors. I on the other hand have had tremendous difficulty.
Unless you are, of course, suggesting that everybody reacts to medications in an identical manner to yourself.
Linkadge
Posted by linkadge on June 8, 2005, at 21:36:56
In reply to Re: This shocked me !! School.. » linkadge, posted by jay on June 8, 2005, at 21:15:04
And like I said, I do very well in school without the medication, so it is not as if I am blaming my lack of success on the medication, I am just saying that people like me have a very hard time on it.
Linkadge
Posted by Larry Hoover on June 8, 2005, at 22:15:16
In reply to Re: This shocked me !! School.. » jay, posted by linkadge on June 8, 2005, at 21:36:56
> And like I said, I do very well in school without the medication, so it is not as if I am blaming my lack of success on the medication, I am just saying that people like me have a very hard time on it.
>
>
> LinkadgeWhat about dose? How much have you played around with very low doses?
I'm a fairly big lad, but it doesn't take much of a dose to bring me to my knees.
Maybe a good number of my drug failures (generally in the poorly tolerated category) are simply because I took too much from the very beginning.
Lar
Posted by Declan on June 8, 2005, at 23:14:12
In reply to Re: This shocked me !! » linkadge, posted by fires on June 8, 2005, at 21:22:42
Minaprine, amineptine.
Posted by linkadge on June 9, 2005, at 15:09:27
In reply to Re: This shocked me !! » linkadge, posted by fires on June 8, 2005, at 21:22:42
Yes, Effexor, and Cymbalta do offer some advantages for some people with depression.
I guess I just suppose that I am disapointed that I hear of all these new drug mechanism avenues, but never see any substance.
Linkadge
Posted by linkadge on June 9, 2005, at 15:12:13
In reply to Re: This shocked me !! School.. » linkadge, posted by Larry Hoover on June 8, 2005, at 22:15:16
This is true, I too do better on small doses of AD's.
I did very well on just 10mg of celexa. Every doctor I saw either said,
"thats too small to do anything, lets bump it up"
or,
"if you're doing ok on 10mg you'd do fine on nothing"
Its hard to find good doctors. Doctors who have perhaps ingested these substances once or twice themselves to get an idea of what they are exposing their patients to.
Linkadge
Posted by linkadge on June 9, 2005, at 15:13:19
In reply to Re: This shocked me !!, posted by Declan on June 8, 2005, at 23:14:12
Yes!, these are good drugs. They imrpove mood and prevent retarditity and the same time.
Linkadge
This is the end of the thread.
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