Mixed Result in Treating Schizophrenia Pre-Diagnosis

[Rootsie]

http://www.nytimes.com/2006/05/01/health/01psych.html?ex=1146628800&en=c122ce84e537e64d&ei=5087%0A

In recent years, psychiatric researchers have been experimenting with a bold and controversial treatment strategy: they are prescribing drugs to young people at risk for schizophrenia who have not yet developed the full-blown disorder.

The hope is that while exposing some to drugs unnecessarily, preemptive treatment may help others ward off or even prevent psychosis, sparing them the agonizing flights of paranoia and confusion that torment the three million American who suffer schizophrenia.

Yet the findings from the first long-term trial of early drug treatment, appearing today in The American Journal of Psychiatry, suggest that this preventive approach is more difficult to put into effect — and more treacherous — than scientists had hoped.

Daily doses of the antipsychotic drug Zyprexa, from Eli Lilly, blunted symptoms in many patients and lowered their risk of experiencing a psychotic episode in the first year of treatment, the study found. But the drug also caused significant weight gain, and so many participants dropped out of the study that investigators could not draw firm conclusions about drug benefits, if any.

The long-awaited study, which was financed by Eli Lilly and the National Institute of Mental Health, raised more questions than it answered, experts said.

"The positive result was only marginally significant, and the negative result was clear," said Dr. Thomas McGlashan, a professor of psychiatry at Yale and the study's lead author. "This might discourage people, and legitimately so, from using this drug for prevention because of the weight gain, but hopefully it won't discourage study" of other drugs.

Critics have charged that treating people for a disorder that has not yet been diagnosed is not only premature but stigmatizing, especially for adolescents. The new study was intended in part to clarify the trade-off between the risks and the potential benefits of preemptive treatment.

"Unfortunately, the study's numbers are so small that it cannot be decisive on the key issue, which is whether it's prudent to treat people early when there are uncertainties about the diagnosis and given the effect of stigma and adverse effects," said Dr. William Carpenter, director of the Psychiatric Research Center at the University of Maryland, who was not involved in the study.

The study was plagued by recruitment problems from the beginning, in 1997. Mild, psychosis-like symptoms are rare in adolescents, and families often wait until symptoms are pronounced before seeking treatment, Dr. McGlashan said. Good candidates trickled in slowly; and the researchers added several recruitment sites along the way to increase the numbers of people in the study.

They eventually enrolled 60 people, most of them adolescents, who scored highly on a scale that assesses risk for psychosis. The scale rates severity of more than a dozen symptoms, including suspiciousness, grandiosity and bizarre thoughts. From 20 to 45 percent of people who score high on the scale go on to develop full-blown psychosis, in which these symptoms become extreme, researchers have found.

The researchers split the participants into two groups, one that received drug treatment and one that took placebo pills. In the first year of a two-year trial, 5 of the 31 of those on medication developed full-blown psychosis, compared with 11 of 29 of those who were taking dummy pills.

But by then, more than two-thirds of the young people in both groups had dropped out, making it difficult to interpret differences between them. Some left the study without explaining why; others moved; and 10 of those on medication quit the study because they felt the drug was not working, could not make the appointments or did not like the side effects, among other reasons.

Those on medication gained an average of 20 pounds during the study. Weight gain is a common side effect of Zyprexa.

"It's a pessimistic trade-off, the weight gain and other side effects for what looks like a modest delay in the acute psychotic episode," said Dr. Steven Hyman, a professor of neurobiology at Harvard. "It's clear we need more efficacious drugs with milder side effects."

[Rootsie]

I work with homeless youth who are human guinea pigs for Zyprexa and other drugs supposedly used to treat mental illness.

I asked the clinical director of my agency whether anybody really knows what the long-term effects of these strong anti-psychotics and antidepressants on adolescent brains, which are as vulnerable and growing and changing as infant brains.

She said no, and that using these drugs is a form of 'triage' used to keep worse things from happening. What a horrifying answer. This amounts to torture.

I know one 22 year-old who has been on 17 different anti-psychotics, and Zyprexa is one of them. She periodically makes half-hearted suicide attempts, one of which will probably someday succeed. She is on SSI and lives in a boarding house run by the local 'mental health' service agency, permanently labelled 'too sick to work' and one of the chronically mentally ill. I watch how she crumples when she's around 'normal' young people. The simplest things just seem impossibly far away.

She just wants to be a happy girl and to live a happy life. What would help her is just so simple: a parental figure to love her unconditionally and help her find a way to be in the world. All the interventions over all the years have wrecked her.

[Rootsie]

http://news.yahoo.com/s/nm/20060606/hl_nm/antipsychotics_children_dc

NEW YORK (Reuters Health) - The prescription of antipsychotic medications for children and adolescents in the US increased nearly 6-fold between 1993 and 2002, according to survey results.

The US Food and Drug Administration has approved only three antipsychotic drugs - haloperidol, thioridazine hydrochloride and pimozide -- for use in patients younger than 18 years, but most of the prescriptions written were for newer medications.

"What was most striking is that nearly one in five -- 18 percent -- of visits to psychiatrists by young people resulted in their being prescribed an antipsychotic medication," lead investigator Dr. Mark Olfson told Reuters Health.

Interest in this issue followed "earlier studies that reported significant increases in the use of antipsychotics by young people within the Medicaid population," the researcher added. "We wanted to find out if this was a general trend that more broadly affects the mental health care of youths in the US."

Olfson, from Columbia University in New York City, and his associates therefore evaluated data from the National Ambulatory Medical Care Survey. Their findings appear in the Archives of General Psychiatry.

The data indicate that "there is a gap between what has been learned in carefully controlled studies and what is actually occurring in practice," the researcher noted.

Approximately 90 percent of antipsychotics prescribed were for the second-generation drugs -- clozapine, risperidone, olanzapine, and quetiapine. None of these drugs are approved for treating adolescents or children.

The researchers note that these drugs were prescribed primarily for disruptive behavior disorders (37.8 percent), mood disorders (31.8 percent), or pervasive developmental disorders or mental retardation (17.3 percent). Only 14.2 percent were prescribed for psychotic disorders.

"It is my guess," Olfson said, that the "water cooler effect," in which "physicians learn from one another informally" during discussions or attendance at professional meetings, "has probably contributed to the dissemination of these kinds of prescribing practices."

A major concern, Olfson said "is that we don't know enough about the metabolic effects of newer antipsychotics, particularly the long-term effects in young people."

SOURCE: Archives of General Psychiatry, June 2006.

[Rootsie]

Poor children, children involved in the foster care system, are behaving in ways we don't like them to, so we drug them. This is torture.

A lot of young people I meet have been in ten or more foster homes in their brief lives. A good number of them were physically or sexually abused in these 'homes.' PTSD? No. Post Traumatic Stress RESPONSE. There are simply some things human beings are not made to bear.

Not surprisingly, more and more of these young people are being vigorously recruited to go over to Iraq. They will return either in body bags or sick beyond repair. They'll probably make excellent soldiers though.