Psychopharmacological Approach.

Introduction:

In ISPS there is a hot debate about the pro and cons of medication. On this page you find links to information how medication works,  what is the best treatment strategy and what can be alternatives. Some people with experience with psychosis choose to use medication in a dose as small as possible, some can manage without. It is different for every person. If you want to stop with medication read the harm reduction guide!

My 6 year anniversary off psych drugs: How I made it through the darkest times, FEBRUARY 9, 2016 BY MONICA CASSANI See you tube

Low dose and/or intermittent use of antipsychotic medication is better than high continuous dose.  

On the 2012 IEPA conference Lex Wunderink presented a talk on a randomized controlled trial that indicates that anti-psychotic medication must be used with precaution, in as low a dose as possible and some people can do without. A RCT found that after 7 years, clients who received medications in as low and intermittent  dose as possible functioned better than clients who received standard medication. http://iepa-vcl.eppic.org.au/content/remission-relapse-and-recovery-following-early-guided-discontinuation-antipsychotics-vs

Psychosocial treatment, antipsychotic postponement, and low‐dose medication strategies in first‐episode psychosis: A review of the literature, John R. Bolaab*, Klaus Lehtinenc, Johan Cullbergd & Luc Ciompie. Psychosis: Psychological, Social and Integrative Approaches, Volume 1, Issue 1, 2009 pages 4-18, http://www.tandfonline.com/doi/full/10.1080/17522430802610008#abstract

How to minimize doses of neuroleptics?

See  A Guide to Minimal Use of Neuroleptics: Why and How
by Volkmar Aderhold, MD and Peter Stastny, MD. 

General information on medication  

Drugs.com http://www.drugs.com/An excellent site to obtain general information about all existing medications: side effects, interactions, a pill-identifier and so forth,  for clients and professionals

Also information on drugs from the institute of psychiatry in London, http://www.mentalhealthcare.org.uk/antipsychotic_medication

And http://www.mentalhealthcare.org.uk/view_all_videos

Randomized Controlled Trials

The evidence that medication works has to be based on Randomized Controlled Trials

What is a randomized controlled Trial? From  Wikipedia https://en.wikipedia.org/wiki/Randomized_controlled_trial

An example of an important RCT : Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment, SW Lewis, L Davies, PB Jones, TRE Barnes,4 RM Murray,5 R Kerwin,5 D Taylor,5 KP Hayhurst,A Markwick, H Lloyd and G Dunn http://www.hta.ac.uk/fullmono/mon1017.pdf

The function of D2 receptors in the brain

Most antipsychotics block D2 dopamine receptors. What is the function of dopamine?

This video describes some of the cognitive functions of dopamine in your brain  https://www.youtube.com/watch?v=ZjH8_hHtumo&list=PLE20D5DB24D28A3C2

The working of neurotransmitters. https://www.youtube.com/watch?v=p5zFgT4aofA

The role of the basal ganglia in psychosis, advanced information, from Paul Morrison for Robin Murray, researcher on cannabis and psychosis https://vimeo.com/11955410

Side effects of antipsychotic medication

Movement disorders like Akathisia and dystonia, https://www.youtube.com/watch?v=0Rif_ri4iRs

Acute Dystonic Reaction https://www.youtube.com/watch?v=2krwEbm5hBo A patient treated with risperidone presents to the emergency department with an acute dystonic reaction. The acute management of the extrapyramidal effect of his medication with benadryl is demonstrated in this video

Tardive Dyskinesia https://www.youtube.com/watch?v=HEKxWzvoD7M A potential drug like haloperidol was notorious for this kind of late and difficult to treat side effect. Especially in US Haldol was given in a far too high  dose for most patients  (5mg or more). The higher the total dose in a life time the higher the chance of TD!

Newer medication have the name that they don’t give this movement disorders. However drugs like olanzapine can give another side effect: diabetes.

Diabetes, Psychiatric Disorders, and the Metabolic Effects

 Maria D. Llorente, MD and  Victoria Urrutia, MD, http://clinical.diabetesjournals.org/content/24/1/18.full Diabetes and adiposities are very frequent and serious side effects of the so-called new antipsychotics. Pharmaceutical industry claimed that they have fewer side effects than the so-called  old antipsychotics, but a main criticism on comparing studies is that the ‘old’ antipsychotics were dosed far too high! A drug like Haldol does work in a dose of 1 to 3 mg. Doses like 10 mg were given!

The critics on medication

Robert Whitaker is one of the main critics of medication. His view is that medication causes changes in the brain and when patients discontinue the drugs abruptly, they get a psychosis because of a rebound effect. https://www.youtube.com/watch?v=z0ofJyCoLWQ https://www.youtube.com/watch?v=5wELX6xaRVc

Midstream psychiatry on medication:

Professor Bernard Lerer on 'Pharmacogenetics of Antipsychotic Drug’ https://www.youtube.com/watch?v=q4V2bDPnXiw A more midstream lecture on antipsychotics, most psychiatrists will agree with the content. Most psychiatrists admit that antipsychotic medication can diminish acute psychotic symptoms, but not chronic symptoms and do not diminish problems with cognitive functioning

The opinion of brain scientists on psychotherapy

Scientist used to think that the brain was formed during early ages, but this proved to be not true. That’s why experiences and not only drugs can change the brain! https://www.youtube.com/watch?v=W9BjRIddG6o

A famous psychopharmaceutic researcher S. Stahl published an article with the same scope http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2710.2011.01301.x/full

Alternatives for medication

A friendly holding environment, like Soteria house, has been proven to be an alternative for psychotic persons to manage their intensive and overwhelming experiences. Soteria house was researched by Mosher and had a better outcome than a day clinic http://www.moshersoteria.com/articles/soteria-and-other-alternatives-to-acute-psychiatric-hospitalization/

Soteria house:Soteria is a community service that provides a space for people experiencing mental distress or crisis. Based on a recovery model, common elements of the Soteria approach include primarily non-medical staffing; preserving resident's personal power, social networks, and communal responsibilities; finding meaning in the subjective experience of psychosis by "being with" clients; and no or minimal use of antipsychotic medication (with any medication taken from a position of choice and without coercion). http://en.wikipedia.org/wiki/Soteria_%28psychiatric_treatment%29

In Finland, family with a psychotic person are visited from the very first day, while everybody including the psychotic person tells about his or her experiences, the meaning of psychosis becomes clear. OPEN DIALOGUE: 74-minute documentary film on the Western Lapland Open Dialogue Project, the program presently getting the best results in the developed world for first-break psychosis -- approximately 85% full recovery, a far majority off antipsychotic medication.Filmed in Finland. Directed by Daniel Mackler. https://www.youtube.com/watch?v=HDVhZHJagfQ

Stopping medication

Coming Off Psych Drugs: A Meeting of the Minds" (on coming off psychiatric medication)COMPLETE DOCUMENTARY FILM. More than half the film's subjects have successfully come off a variety of medications, including antipsychotics, mood stabilizers, antidepressants, and benzos, and several participants give trainings on the process. Here they tell how they did it and they provide a philosophy and framework for coming off. https://www.youtube.com/watch?v=Q5EpnVdLvkU

Coming Off Psychiatric Drugs Workshop with Will Hall, a workshop https://www.youtube.com/watch?v=LDgw36LgPcw

When you want to try to stop medication, or you want to guide your client, do it  wisely! The harm reduction guide is an excellent guide. http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf

A bit older book on coming of drugs is from Peter Lehman. Peter (ed.). (2002). Coming off Psychiatric Drugs http://www.peter-lehmann-publishing.com/books/withdraw.htm     

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