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USA Today (Society for the Advancement of Education) - The dark side of psychiatric drugs - The United States of Violence: A Special Section - Cover Story

admin — Thu, 08 Jan 2009 13:41:05 +0000

Thorazine, Haldol, and other medication prescribed by psychiatrists can destroy the lives of people who take them.
Virtually all person who go to psychiatrists are put on one or more drugs. However, psychiatric drugs, which are unpredictable and extremely deadly, do not cure anything, and instead destroy the life of the person who takes them.
The most dangerous of these are major tranquilizer, also known as neuroleptic (nerve-seizing) drugs or anti-psychotics. Of the more than two dozen in this class, introduced in the mid 1950s, the most commonly used are Haldol (haloperidol), Compazine (prochlorperazine), (Thorazine (chlorpromazine), Navane (thiothixene), Prolixin (fluphenazine), Mellaril (thioridazine), and Trilafon (perhenazine).

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Their purpose is to create “maximum behavioral disruption” - a goal clearly reflected in 1950 tests conducted with rats on Thorazine. Through chemicals, psychiatrists sought to sabotage thought processes and thereby deny the person control of his own body.
At the time the major tranquilizers were introduced, the lobotomy was touted highly and widely used by psychiatrists. With the procedure, the shredded brain was damaged forever, generating objections from family and friends of the patient.
The major tranquilizers were able to create a zombie state, identical to that seen after a lobotomy, in a person whose brain remained intact. For this reason, Thorazine became known as a “chemical lobotomy.”
“[On Thorazine] my thoughts spun and never got too far. My hands were rubber and I could hardly hold a fork,” said one patient who had been put on the drugs by a psychiatrist. “After six weeks … I felt like my mind had been put through a meat grinder. No longer could I think clearly; no longer could I speak articulately; no longer could I act confidently.”
Another stated that, after a week on Haldol, “I was unable to speak. No matter how hard I tried, I couldn’t say anything out loud and spoke only with the greatest difficulty …. It was as if my whole body was succumbing to a lethal poison.”
The horrifying mental upheaval and devastation this lobotomizing effect causes was precisely what appealed to psychiatrists. These chemicals would enable people to be warehoused with the least “inconvenience” to psychiatrists and staffs of psychiatric institutions.
Today, these drugs are being used against the elderly in enormous quantities to straitjacket them chemically. By 1985, the National Disease and Therapeutic Index reported that, while adults 60 years and older made up 11% of the population, they used more than one-third of all antipsychotic drugs. A study of 2,000 pharmacies in 1986 showed that 60.5% of prescriptions for nursing home residents over 65 years of age were for major tranquilizers and 17. 1% for minor versions.
A Harvard Medical School study of 55 Boston-area rest homes published in the Jan. 26, 1989, issue of The New England Journal of Medicine reported that 55% of the 1,201 nursing home residents it surveyed took at least one psychiatric drug, with 39% being given anti-psychotics.
These are not prescribed to “treat” any condition. They are administered solely to turn the patient into a zombie incapable of complaining or presenting problems to staff. Concerning their use on the elderly, Jerome Avorn, director of the program for the Analysis of Clinical Strategies at Harvard, pointed out, “Drugs do work. They do quiet them down. So does a lead pipe to the head.”
Larry Hodge, administrator at the Life Care Center in Tennessee, described the impact on the elderly of these drugs: “Too often they were so zonked out during their meals that their heads were in the mashed potatoes.”
Wilda Henry told The Arizona Republic that her 83-year-old mother became “a vegetable” five weeks after taking Haldol. This powerful mind-altering chemical, which the Soviet Union used for years to control dissidents, left her mother babbling, drooling, shaking, and unable to control her bowel functions.
Anise Debose of Washington, D.C., said her 76-year-old father entered a nursing home active, laughing, and talking. Four days later, after taking Mellaril and four other drugs, “He was restrained to a chair as rigid as a board when I saw him. His head was thrown back and his mouth was limply hanging down. Both eyes were closed. The impression all of us had was that he was dead.”
In 1989, the U.S. Senate Select Committee on Aging reported that, while those over 60 years of age make up 17% of the population, they accounted for more than half the fatalities resulting from drug reactions. According to the American Hospital Association, of the 10,800,000 elderly admitted to hospitals each year, 1,900,000 are due to drug reactions. Four percent of those cases, an estimated 76,000 elderly a year, die. This annual death rate far exceeds the 58,021 Americans who lost their lives during the Vietnam War. An average of more than 200 elderly Americans die each day from drug reactions.
“People don’t just die of old age,” Theodore Leiff, professor of gerontology, Eastern Virginia University School of Medicine, points out. “Their deaths are caused by something.” As case after case demonstrates, they are being killed behind the locked doors of nursing homes by lazy, incompetent, or criminal psychiatric staffs who use deadly drugs to quash complaints before they ever are voiced.

Annals of the American Psychotherapy Association - The conventional long-acting antipsychotics

admin — Tue, 06 Jan 2009 15:26:03 +0000

In the last primer, we discussed the first long-acting formulation of an atypical antipsychotic, Risperdal Consta, which became available in 2003. For the sake of completeness regarding this primer, it should be noted that long-acting forms of two conventional antipsychotics were developed in the 1960s, namely fluphenazine (Prolixin) decanoate and haloperidol (Haldol) decanoate. They have a risk versus benefit profile less favorable than the atypical antipsychotics (1) but have assisted with compliance and subsequently decreased both relapse rates and re-hospitalizations in comparison to oral neuroleptics over extended periods of time. (2)

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Haldol decanoate is administered intramuscularly and results in a slow and sustained release of haloperidol. The indications and target symptoms are similar to those for oral Haldol, but the duration of action is longer. Haloperidol decanoate reaches a peak at about 6 days and has an apparent half-life of about 3 weeks. Steady state plasma concentrations are achieved after the third or fourth dose. It is indicated for the treatment of patients who have schizophrenia and require prolonged parenteral antipsychotic therapy. It blocks the effects of dopamine and increases its turnover rate; (3) however, the exact mechanism of action is unknown.
It is available in two doses: 50 and 100 milligrams (mg). Patients should be tried on the oral formulation to establish tolerability and response. The initial decanoate dose is 10-20 times the previous daily oral dose; however, the elderly, debilitated, or those maintained on low doses may need lower doses and a conversion factor of 10-15 times the previous oral dose. Regardless of the conversion, the first dose should not exceed 100 mg. If the conversion requires more than 100 mg, then it should be administered in 2 injections, with a maximum of 100 mg in the first shot followed by the remaining in 3-7 days. It is usually administered every 4 weeks (monthly), but patient response may warrant a more frequent dosing interval. Clinical experience at doses greater than 450 mg a month has been limited. (3)
Fluphenazine decanoate is available for both intramuscular and subcutaneous administration. The onset of action is between 24 and 72 hours after injection and the effect on psychosis becomes significant within 48-96 hours. Like haloperidol decanoate, it is intended for the management of patients with schizophrenia who require prolonged parenteral neuroleptic treatment, but the exact mechanism of action is unknown.
Patients should be started on a short-acting formulation of fluphenazine to determine dose and response. A 10 mg daily dose of oral fluphenazine conforms approximately to 12.5 mg of fluphenazine decanoate every 3 weeks. For most patients a dose of 12.5 mg or 25 mg may be given to initiate therapy. Subsequent injections and the dosage interval are determined in accordance with the patient’s response. If doses greater than 50 mg are deemed necessary, the next dose and succeeding doses should be increased cautiously in increments of 12.5 mg. Dosage should not exceed 100 mg. (4)
Both haloperidol decanoate and fluphenazine decanoate can cause the following adverse effects: sedation, hyperprolactinemia, extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, and acute dystonic reactions. These preparations are esterified in a sesame oil vehicle, so both acute and cumulative local reactions at the injection site are possible. As with other antipsychotic agents it should be noted that they can potentiate central nervous system depressants such as anesthetics, opiates, and alcohol. They are contraindicated in comatose states and known hypersentivity. Haloperidol decanoate is classified as category “C” in pregnancy; there is no current evidence of fetal damage. Fluphenazine decanoate is not intended for use in children under 12 years of age, and its safety in pregnancy has not been established. Cardiac effects of Haldol may include prolongation of the QT segment on the electrocardiogram and changes compatible with the polymorphous shapes of torsades de pointes. (3,4)
A risk-benefit assessment with long-term depot antipsychotics showed that the main advantage was in overcoming noncompliance. Further, it reduced the individual variation in bioavailability, metabolism, and maintained stable plasma concentrations over long periods. (5) A pharmaco-economic model showed considerable cost savings with haloperidol decanoate versus oral Haldol or oral Risperdal. (6)
CME/CREDIT
CE/CREDIT
This 1-credit continuing education opportunity is co-sponsored by the American College of Forensic Examiners International (ACFEI) and the American Psychotherapy Association. ACFEI maintains responsibility For all continuing education accreditations. This article is approved by the following for 1 continuing education credit:
APA provides this continuing education credit for Diplomates.
This program is co-sponsored by ACFEI and APA. ACFEI is approved by the American Psychological Association to offer continuing education for psychologists. ACFEI maintains responsibility for the program.

Legal Eagle Eye Newsletter for the Nursing Profession - Combative patient: jury rules hospital staff not liable

admin — Sat, 03 Jan 2009 15:36:03 +0000

The seventy-nine year-old patient was admitted to the hospital’s intensive care unit for diabetic ketoacidosis.
The next evening she removed her monitor hook-ups, got out of bed and insisted that she would be leaving. Three nurses put her back to bed.
A few hours later her behavior became outright combative. Multiple staff members had to intervene. During the struggle the patient’s arm got caught between the mattress and the side rail.
One of the nurses lowered the bed rail to release her arm, but her arm and both legs were broken. After surgery the patient died a week later from her injuries
The family filed suit against the hospital in the Supreme Court, New York County, New York.

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No Haldol Given After First Episode of Confusion
The jury apparently discounted the family’s lawyer’s argument that Haldol should have been given when the patient first exhibited signs of confusion.
Instead, the jury accepted the hospital’s assertion that the first episode of mere confusion did not justify a chemical restraint. Nor would that episode necessarily lead staff to anticipate a full-blown combative episode would follow in which the elderly patient, suffering from advanced osteoporosis, would be badly injured. Estate of Klein v. North Shore Univ. Hosp., 2007 WL 1247192 (Sup. Ct. New York Co., New York, March 29, 2007).
COPYRIGHT 2007 Legal Eagle Eye Newsletter for the Nursing Profession
COPYRIGHT 2008 Gale, Cengage Learning

Newsweek - Long Shot

admin — Thu, 01 Jan 2009 12:21:02 +0000

As jury selection in the Andrea Yates trial wrapped up this week, the Houston mother accused of drowning her five children seemed at ease. She smiled, waved and mouthed “I love you” to her mother and mother-in-law when they left the courtroom.

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It’s a far cry from the near-catatonic demeanor she showed on the morning of June 20 when she was led in handcuffs away from the family’s Clear Lake home, where police found her dead children, ages 6 months to 7 years. With the help of Haldol, an antipsychotic drug, and psychiatric treatment at the Harris County Jail, Yates’s health has improved over the last several months, relatives say. “She still has a lot of confusion,” her brother, Andrew Kennedy, tells NEWSWEEK. “But she has a good sense of humor.” He says she recently joked, “Does Rusty ever keep his mouth shut?” referring to a series of …

Read the full article with a Free Trial at MyWire.

Southern Review, The - Haldol

admin — Mon, 29 Dec 2008 00:06:03 +0000

I’ll wear a long-sleeve shirt with cuffs
for protection–never restrain
an escalated girl alone–since the night
the Haldol wore so thin
she sputtered saliva and flung her weight
against each lock on the ward
I’d bolted, tight as the door of seclusion,
which only opens out
so she can’t kick it shut and trap us in.
That night her teeth chewed the skin up
and down my arms, leaving
ragged welts and contusions the doctors
in Emergency merely stitched
with scars. Now the pulse of each ambulance
sends me deeper into what
fluorescent light refracts, the tick and jump

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of dayroom walls. Now another
new foster father hugs the girl, whose posture
we’ve perfected over years with straitjackets,
dorsal horn of her spinal cord
so medicated he can’t imagine bandages
like mine might ever wrap
his arms. So today I’ll remind her how to slip
her arms willingly into the satin
sleeves of a warm coat, I’ll watch her
button it tight as the jaws
that clenched, the human bite that won’t let go.
COPYRIGHT 1998 Louisiana State University
COPYRIGHT 2008 Gale, Cengage Learning

Clinical Psychiatry News - Quetiapine rivals lithium, haloperidol

admin — Sat, 27 Dec 2008 16:06:02 +0000

SAN Francisco - Quetiapine monotherapy for bipolar I mania is as effective as lithium or haloperidol–and with markedly fewer side effects, Martin W Jones, Ph.D., said at the annual meeting of the American Psychiatric Association.
He reported on a pooled analysis of two double-blind phase III clinical trials involving 604 patients with a manic episode of bipolar I disorder who were randomized to 12 weeks of quetiapine (Seroquel), placebo, lithium, or haloperidol (Haldol).
The results were used by AstraZeneca Pharmaceuticals in its recent filing for a new indication for quetiapine as monotherapy or adjunctive therapy for acute mania associated with bipolar depression.

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That application remains under review by the Food and Drug Administration. Quetiapine is currently indicated only for treatment of adult schizophrenia, noted Dr. Jones of AstraZeneca in Wilmington, Del.
The 12-week studies were completed by 60.8% of patients randomized to the atypical antipsychotic and 38.9% on placebo.
Beginning on day 4, quetiapine-treated patients experienced significantly greater improvement than those on placebo.
COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning

Internal Medicine News - Haloperidol may raise risk of heart arrhythmia

admin — Sun, 21 Dec 2008 12:56:04 +0000

Patients taking the antipsychotic drug haloperidol may be at increased risk for heart rhythm abnormalities, according to a Food and Drug Administration alert.
Revised labeling on the drug, marketed as Haldol, Haldol decanoate, and Haldol lactate, includes a cardiovascular subsection explaining the increased risk for prolonging the QT interval. The risk for arrhythmia appears to be greater when the drug is given in doses above the recommended amounts, or when it is given intravenously. The FDA advises clinicians to review the cardiac histories of patients who take haloperidol.

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For more information, contact the FDA by visiting www.fda.gov/medwatch/safety/2007/safety07.htm#Haloperidol.
COPYRIGHT 2008 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning

Bipolar Disorder

admin — Tue, 16 Dec 2008 01:36:02 +0000

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and their ability to function. It is an illness that affects thoughts, feelings, perceptions and behavior and is distinguished from Major Depressive Disorder by the presence of manic or hypomanic episodes. It can cause dramatic mood swings from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between.
Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from several days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most scientists now agree that there isn’t a single cause for bipolar disorder rather, many factors act together to produce the illness.
It is classified according to symptom severity as Bipolar Disorder I, Bipolar Disorder II, and Cyclothymic Disorder. Bipolar Disorder Type I is usually characterized by at least one manic episode, with or without major depression. It involves episodes of severe mood swings,from mania to depression and is the classic manic-depressive form of the illness as well as the most severe type.
Bipolar II disorder is usually a milder form, involving milder episodes of hypomania that alternate with depression. Some people never develop severe mania but instead experience milder episodes of hypomania that alternate with depression.
When four or more episodes of illness occur within a 12-month period, a person has rapid-cycling bipolar disorder.
Bipolar disorder will typically develop in late adolescence or early adulthood. In children or teens it can be difficult to distinguish from other problems such as attention-deficit hyperactivity disorder (ADHD), conduct disorder, oppositional defiant disorder, and depression. It can also manifests in late life as well. Bipolar disorder may appear to be a problem other than mental illness - alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships for instance.
Bipolar disorder affects more than one in forty American adults and affects men and women equally. Bipolar disorder often runs in families, and recent studies suggest a genetic component to the illness.
Different from the normal ups and downs that everyone can go through, the symptoms of bipolar disorder are severe. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives. Most people can achieve substantial stabilization of their mood swings and related symptoms with proper treatment. Between episodes, many people with are free of symptoms, but as much as one-third of people have some residual symptoms.
Treatment, in disabling bipolar disorder, is with mood stabilizers (classically, the lithium salts) that balance the manic and depressive states experienced by patients. Treatment and maintenance of this disorder is necessary throughout a person’s life once bipolar disorder has been diagnosed. Treatments may include medication, talk therapy, and/or support groups.
The following medications may be used to treat bipolar disorder (many patients are treated with a combination of two or more of these medications):
Lithium
A mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
Valproate (Depakote), carbamazepine (Tegretol), lamotrigine, topiramate
Antiseizure medications, also used as mood stabilizers instead or in combination with lithium.
Benzodiazepines, clonazepam (Klonopin) or lorazepam (Ativan)
Can be used to treat agitation or insomnia.
Zolpidem (Ambien)
Used to treat insomnia.
Antidepressants
Serotonin reuptake inhibitors or bupropion (Wellbutrin) can be used to treat depression.
Antipsychotic medications
Uused for acute manic or mixed episodes and maintenance treatment.
Classic antipsychotic medications (eg, haloperidol (Haldol)) are not often used because of risks of tardive dyskinesia (uncontrollable movements).
Atypical antipsychotic medications (eg, risperidone, olanzapine, aripiprazole, zisprasidone, and quetiapine) are more effective with less risk of tardive dyskinesia Treatment may need to be continued for prolonged periods or indefinitely, depending on the pattern of the illness, to prevent significant mood swings.
Treatment of depression may also include support groups, talk therapy or other strategies that you and your health care provider may want to try. Treatment should not be postponed, however, because of the risk of suicide and school failure.

Indiana Business Magazine - Taking stock: Indiana stocks worth watching in 2008.(INVESTMENTS)(Company overview)

admin — Wed, 10 Dec 2008 14:56:05 +0000

Background: First-generation antipsychotics have been the treatment of choice for acute mania with or without psychosis. However, because these agents may cause severe side effects and may worsen depressive symptoms in patients with bipolar disorder, they have limited use in these patients. Second-generation antipsychotics developed over the past few years have proven to be effective in the treatment of acute mania in bipolar disorder. These medications cause fewer side effects than the first-generation agents, do not appear to induce depressive episodes, and may have some antidepressant effect. One recent study found that there is significant variation in practice patterns when treating acute mania in bipolar disorder. To answer concerns about the effectiveness and safety of second-generation antipsychotics for this indication, Scherk and colleagues performed a meta-analysis of published randomized controlled trials.

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The Study: The authors searched the PsiTri and Medline databases for published and unpublished randomized controlled trials evaluating the effectiveness of second-generation antipsychotics in the treatment of acute mania in bipolar disorder. (PsiTri registers controlled trials that compile the published studies for the mental health field from all Cochrane review groups.) The second-generation antipsychotics included aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon), and zotepine (Zoleptil). The primary outcome extracted from the literature was the mean change in the Young Mania Rating Scale score or similar scale scores from baseline to end point. Other outcome measures were response rate, effectiveness criteria (e.g., rates of dropout because of side effects or lack of effect), weight gain, rate of somnolence, and extrapyramidal symptoms.
Results: Twenty-four studies met the inclusion criteria, with a total of 6,187 patients. The studies compared second-generation antipsychotics with placebo, mood stabilizers, placebo in addition to mood stabilizers, or haloperidol (Haldol). Second-generation antipsychotics were significantly more effective than placebo and had effectivity similar to that of mood stabilizers. Participants who received the combination of second-generation antipsychotic and mood stabilizers had better response than those who were treated with only a mood stabilizer. Response rates for second-generation antipsychotics and haloperidol were similar. With regard to side effects, some second-generation antipsychotics were associated with an increased risk of extrapyramidal symptoms and somnolence compared with placebo.
Conclusion: Published data suggest that second-generation antipsychotics in addition to mood stabilizers are the best treatment strategy for acute mania. This combination resulted in greater reduction in mania scores, better response rates, and fewer dropouts resulting from ineffective treatment.
KARL E. MILLER, MD
Source: Scherk H, et al. Second-generation antipsychotic agents in the treatment of acute mania. Arch Gen Psychiatry April 2007;64:442-55.
COPYRIGHT 2007 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning

Schizophrenia Drug Face-Off: No Clear Winner

admin — Tue, 09 Dec 2008 06:51:02 +0000

Sept. 19, 2005 — Mental health experts say it wasn’t a horse race. That explains why there’s no clear winner from a major government study pitting a new generation of schizophrenia drugs against one another.
Zyprexa was the most effective of the drugs. But its greater number of side effects dims its first-place finish.
Meanwhile, a come-from-behind, second-place finish by Trilafon — a little-known old horse that nobody thought had a chance — may rescue the older generation of schizophrenia drugs from being put out to pasture.
Funded by the National Institute of Mental Health (NIMH), the five-year study enrolled 1,500 schizophrenic patients at 27 U.S. medical centers. Neither patients nor their doctors knew whether they were getting Zyprexa, Seroquel, Risperdal, Geodon, or the older Trilafon. Jeffrey A. Lieberman, MD, now director of the New York Psychiatric Institute, led the study while at the University of North Carolina in Chapel Hill.
“These drugs work, but have limitations: 74% of patients in the study elected to seek something better rather than stay on their assigned medication,” Lieberman said today at an NIMH news conference. “When it comes to treatment, the glass is only half full. We all want more efficacy and fewer side effects. But make no mistake: These drugs do work.”
The study findings appear in the Sept. 22 issue of The New England Journal of Medicine.
‘Traditional’ Drug vs. Newer ‘Atypical’ Drugs
Schizophrenia is a frightening mental illness afflicting 3.2 million Americans. Usually beginning at age 18 to 24, patients suffer hallucinations, delusions, and disordered thinking. There is no cure. But treatments can greatly reduce the intensity of symptoms.
“Fifty years ago we would have been talking about people institutionalized in state hospitals,” NIMH director Thomas R. Insel, MD, said at the news conference. “Then there came drugs, such as Thorazine and Haldol, which proved quite effective in reducing symptoms and the need for hospitalization.”
These traditional antipsychotic drugs can have devastating side effects resembling Parkinson’s disease: tremor, rigid muscles, and abnormal or restless movements.
About 12 years ago, the new generation of “atypical” antipsychotic drugs came along. These drugs were much less likely to cause Parkinson’s-like side effects. But they came with side effects of their own — extreme weight gain and an increased risk of type 2 diabetes Even so, 90% of schizophrenia prescriptions are for one of these six drugs.
Clinical trials show that the drugs work better than no drugs at all. But the trials never told doctors how the drugs would work relative to one another. That’s why the NIMH sponsored the trial, known as the Clinical Antipsychotic Trials of Intervention Effectiveness or CATIE.
The trial included Trilafon to represent the traditional antipsychotic drugs. It also included four other atypical antipsychotics. Clozaril was not included in the first phase of the trial because it will be tested as a second-line treatment for patients who switch from one of the original drugs in the trial. Those results will be reported later.