Violenza, psicofarmaci e complicità dei mass media

La guerra umanitaria è un falso ideologico

376787_389326921131618_1422656183_n I media sono complici di massacri

Gli psicofarmaci possono indurre comportamenti violenti

Adam Lanza autore della strage in una scuola elementare a Newtown nel Connecitucut il 14 dicembre 2012, sarebbe stato in diretta competizione con Anders Breivik il mass murderer norvegese autore nel luglio del 2011 della strage di giovani nell’isola di Utoya. E’ quanto riferisce l’emittente CBS sulla base di fonti rimaste anonime. La notizia, secondo il portavoce del polizia del Connecticut, sarebbe puramente speculativa. In realtà , indipendentemente da fatti che provino la validità dell’ipotesi emulativa , sono riscontrabili negli innumerevoli episodi di mass shooting commentati nei media di tutto il mondo, dei tratti comuni, individuati anche in studi di psichiatria forense, che fanno pensare ad una componente “imitativa”.

Molti dei soggetti, autori di stragi ai danni di individui inermi e quindi bersagli ideali, hanno dei profili psicologici compatibili con una diagnosi di schizofrenia come nel caso di Breivik e di Lanza. Ora che uno schizofrenico imiti un altro schizofrenico o che un gruppo di schizofrenici possa creare uno stile particolare e riconoscibile di omicidio di massa , mette in discussione conoscenze psichiatriche che sembravano acquisite. Noi sappiamo che il termine schizofrenia fu coniato da Eugen Bleuler nel 1913 il quale , ispirandosi, a Freud ritenne che le persone affette da questa malattia vivessero in un mondo a parte perdendo la capacità di condividere con altri esseri umani affetti, valori ed obiettivi. Lo schizofrenico sarebbe stato simile ad un anacoreta per ritiro progressivo dalla società. Bisogna ricordare che Freud, che non ha mai avuto in carico uno schizofrenico da lui riconosciuto come tale, riteneva che nella psicosi ci fosse una incapacità assoluta di stabilire un transfert o vivere una risonanza empatica con chicchessia per effetto della regressione che avrebbe riattivato una condizione di isolamento , cioè di narcissimo assoluto simile a quello del neonato. Questa idea rivelatasi poi completamente falsa sia alla luce della ricerca psichiatrica successiva che degli sviluppi della neonatologia, ha escluso le forme schizofreniche dal trattamento analitico classico ritenuto inadatto se non addirittura pericoloso per le forme di schizofrenia latente.

Ora se Lanza , come anche il professore universitario che, recentemente, in Polonia voleva fare un attentato al parlamento con una potentissima bomba, ha imitato Breivik, com’è verosimile pensare , e se quest’ultimo ha tratto a sua volta ispirazione dall’Una bomber americano, il matematico che uccideva per fare propaganda al suo libro-Manifesto, e se altri hanno perseguito strategie criminali analoghe, noi saremmo di fronte al fatto che gli schizofrenici si influenzano ed entrano in risonanza gli uni con gli altri determinando addirittura uno stile criminale , sfidandosi sullo stesso terreno come in un videogioco on line.

Che cosa dobbiamo concludere? che siamo di fronte ad una evoluzione nel modo di manifestarsi della schizofrenia a cui deve far seguito un adeguamento delle nostre categorie psicopatologiche e diagnostiche?

invenzione perversa del padre di Daniel Schreber

Che ne sarà allora delle concezioni organicistiche che sostengono la “naturalità” della malattia mentale legata a cause biologiche e genetiche? Il diabete dal tempi di Ippocrate ad oggi non è molto cambiato mentre sembra difficile pensare ad una schizofrenia che attraversi le epoche e le culture mostrando dei tratti immodificabili come quelli del diabete . Il famoso presidente Schreber, il giudice affetto da schizofrenia paranoide, pubblicò nel 1903 Memorie di un malato di nervi che sono state un materiale di riflessione per i tutti i più importanti psichiatri e psicoanalisti del 900 come lo stesso Freud , Jung, Melanie Klein e Jacques Lacan. Del caso Schreber ha dato una originale e magistrale interpretazione Massimo Fagioli nel suo libro Teoria della nascita e castrazione umana la cui prima edizione risale al 1974: la psicosi con caratteristiche allucinatorie e deliranti si sarebbe sviluppata a partire dall’incapacità del tedesco di distinguere, nel passaggio dal sonno alla veglia le immagini mentali dalle percezioni reali. La malattia di Schereber avrebbe dovuto essere la stessa di quella che ha colpito Lanza o Breivik che secondo la prima coppia di periti psichiatri intervenuti al processo per la strage di Utoya avrebbe agito in preda ad allucinazioni e deliri di grandezza e persecuzione.Ma fra la biografia e gli scritti di Schreber che non ha mai fatto male ad una mosca, salvo disturbare i vicini con urla disumane, e per esempio quelli di Breivik , ben 1500 pagine di copia-incolla propedeutiche alla strage, c’è un vero e proprio abisso.

Si potrebbe approfondire la ricerca su quello strano fenomeno che è il mass shooting seguendo una fondamentale indicazione di Fagioli stesso quando egli afferma che se è vero che esiste un’entità nosografica che fa capo al termine schizofrenia è altresì vero che esistono gli schizofrenici. Come dire che nell’ambito di tratti psicopatologici comuni è necessario in ciascuna malattia individuarne la singolarità: ci sono elementi caratteristici presenti in alcuni casi se non addirittura presenti in un solo caso. E’ per questo che il DSM IV (fra poco V ), il più famoso ed utilizzato manuale diagnostico, è inutilizzabile poichè non garantisce la veridicità della diagnosi :vengono proposti criteri generici e descrittivi rilevabilii anche da un computer, che non permettono di individuare il nucleo psicopatologico nascosto della malattia che si manifesta diversamente in ciascun caso.

L’influenza culturale della schizofrenia di Martin Heidegger

L’omicidio di massa, nello stile detto pseudocommando, è una modalità di agire criminale emerso in forma quasi epidemica da pochi decenni prevalentemente negli USA. Verso di esso per una concomitanza di fattori ambientali e personali, possono orientarsi persone con gravi patologie psicotiche ed alterazione profonda del senso di identità. Alcuni mass murderers hanno fatto scuola diventando i capostipiti di una tendenza e tracciando un percorso che altri hanno seguito . Uno studioso americano Louis A. Sass, autore del libro Madness and Modernism: Insanity in the Light of Modern Art, Literature and Thought( 1994) ha sostenuto che pochi individui affetti da patologie più o meno manifestamente schizofreniche hanno avuto una grande importanza non solo sul terreno della psicopatologia e dell’agire criminale, quanto nel campo dell’arte o della filosofia introducendo temi ed atteggiamenti che poi si sono largamenti diffusi. In effetti nell’arte moderna e postmoderna e nella filosofia di derivazione esistenzialista sono ampiamente presenti tematiche “schizofreniformi” evidenti nella stranezza dei contenuti e nell’ipertrofizzazione della coscienza, fredda e lucida che li produce. Il vissuto schizofrenico secondo la studioso americano non tenderebbe a rimanere monadicamente chiuso in se stesso, come sembra suggerire il termine autismo nell’accezione originaria di Bleuer, ma avrebbe una risonanza profonda nell’opinione pubblica e nella cultura come è accaduto per la filosofia di Heidegger.Il paradigma della schizofrenia non è più solo l’introversione ed il deterioramento mentale ma anche l’estroversione e l’azione.

Qual è è la lunghezza d’onda sulla quale si sintonizzano i mass murderers con i loro potenziali proseliti ed imitatori ? Questi ultimi, individui anaffettivi ed insensibili ai normali stimoli sociali, reagiscono con un comportamento imitativo rispetto al modello mass shooting. Siamo di fronte ad un vero e proprio processo di infezione psichica e di induzione all’acting out violento contro la quale alcuni non hanno capacità di resistere. Il punto di vulnerabilità è quella che gli psicopatologi del secolo scorso chiamavano una frattura nella linea della vita cioè un vissuto di totale annullamento del rapporto interumano e di vuoto interiore in un contesto sociale e culturale in cui predomina l’ideologia della guerra: si esalta l’azione eroica ed il ricorso alle armi, sacrificando il valore della vita umana al criterio dell’utilità personale e dell’affermazione megalomanica .

La perversione del denaro ed i mass media

Il quadro di questa nuova psicopatologia non sarebbe completo se noi non includessimo un fattore iatrogeno: l’uso e l’abuso di sostanze psicotrope, sostenuto dalla psichiatria organicistica al servizio delle case farmaceutiche, un vera e proprio miccia per eventi violenti e catastrofici.

Sia Adam Lanza che Breivik hanno agito sotto l’influenza di droghe psicotrope e psicofarmaci che è risaputo possono, in persone predisposte, avere l’effetto di un innesco detonante per condotte di omicidio-suicidio. La scelta della strage, invece dell’omicidio singolo, potrebbe essere motivata dall’effetto di amplificazione della notizia che i mass media perversamente garantiscono a chi commette crimini particolarmente efferati: per un momento di notorietà e di esposizione pubblica si è disposti allora a sacrificare centinaia di vite umane.

Psichiatria, Senza categoria

La cella di Breivik e l’assurdità della pena

Breivik è convinto che nei suoi confronti nel regime detentivo a cui è sottoposto , ci sia una violazione dei diritti umani: egli sarebbe costretto in condizioni di invivibiilità essendo sottoposto a vere e proprie torture per indurlo al suicidio A parte la paradossalità di una dichiarazione del genere fatta da lui che non ha mai provato pietà per le sue vittime ed a parte le immagini della sua cella che parlano da sole a proposito del trattamento disumano cui verrebbe sottoposto, rimane il fatto che un malato di mente gravissimo non deve stare in carcere ma in una clinica psichiatrica. Il regime di isolamento assoluto è una sofferenza inutile che viene inflitta solo a scopo di ritorsione o di punizione ad un soggetto affetto da schizofrenia e delirio di persecuzione. Occhio per occhio dente per dente non è certo un criterio che si addice a chi pratichi la psichiatria. Ora i periti che hanno dichiarato sano di mente Breivik ritenendolo idoneo a sostenere un regime di detenzione e di isolamento che di fatto aggrava la sua patologia mentale non solo hanno infangato la già precaria reputazione della psichiatria con una diagnosi ridicola, ma sono responsabili di un vero e proprio danno iatrogeno perpetrato nei confronti di un individuo che sicuramente non rimane simpatico a nessuno ma che è pur sempre un essere umano e che come tale , a meno che non si voglia diventare come lui, va trattato. Un malato, qualunque cosa abbia fatto, rimane un essere umano ed è una prerogativa del medico evitare di produrre lesioni fisiche od intraprendere azioni che abbiano conseguenze psichiche che non siano finalizzate alla cura. La perizia psichiatrica è finalizzata alla cura od alla punizione ? La limitazione della libertà e dei rapporti deve poter obbedire al criterio di impedire ulteriori episodi di violenza non certo essere utilizzata come strumento di ritorsione inutile in quanto rivolto contro un individuo che non capisce la gravità del gesto che ha compiuto e che quindi considera la pena una persecuzione ed una tortura.

Pertanto la psichiatria del DSMIV , la Bibbia che ha consentito la diagnosi di sanità mentale, è totalmente incapace ma non s0lo sotto il profilo forense, di affrontare i problemi che si presume dovrebbe comprendere e risolvere: essa crea solo confusione ed aggrava la patologia delle persone delle quali si deve occupare .

Nel caso di Breivik l’errore è eclatante ma è rivelatore di un universo sommerso di errori, disseminati a macchia d’olio su scala planetaria ,che rischiano di trasformare gli Usa (ma non solo ), la patria del DSMIV e V, in un manicomio a cielo aperto.

Ed In Italia?

Breivik’s cell and the absurdity of the penalty

What’s the point in keeping a mentally insane in jail? A case of psychiatric malpractice that doesn’t concern only Norway, and that marks the failure of a worldwide school of thought

Domenico Fargnoli

sabato 9 febbraio 2013 12:12

Commenta

Anders Behring Breivik

Anders Breivik is convinced that, with regards to him, there is a violation of human rights in the prison regimen to which he is forced: according to him, he is compelled to an unbearable lifestyle, undergoing true torture practices to induce his suicide. Without mentioning the paradox contained in such a statement, made by a man that never had any kind of mercy for his victims, and without mentioning the pictures of his cell, that clearly speak for themselves about the inhuman treatment to which he is supposedly forced, we still say that the main point is that a severely insane like Breivik shouldn’t be in jail, but in a psychiatric facility. The complete isolation regimen is a totally useless suffering that is inflicted only as a reprisal and as a punishment against a subject that is affected by schizophrenia and delirium of persecution. An eye for an eye, a tooth for a tooth, this is clearly not a valid criterion and surely not suitable for those who deal with psychiatry. Now, the experts that declared Breivik “of sound mind”, believing that he’s capable of sustaining a prison regimen and an isolation that, in fact, do nothing but aggravate his mental pathology, not only sullied the already precarious reputation of psychiatry with a ridiculous diagnosis, but also have the responsibility of a true iatrogenic harm, perpetrated against a person that surely no one would consider “nice”, but that is still a human being and that must be treated as such, unless we also want to become like him. A mentally insane, whatever he could have done, remains a human being, and it’s a precise medical prerogative to avoid producing any physical harm and to avoid carrying out any action that produce psychic consequences that are not aimed at the cure. Is the psychiatric evaluation aimed at the cure or at the punishment? Limiting freedom and social relations should obey the rule of impeding subsequent violent episodes, and shouldn’t be used as a useless reprisal instrument; useless inasmuch applied to a man that does not understand the seriousness of what he’s done, and that, therefore, considers penalty just as a persecution and a torture.

For these reasons the psychiatry carried out by the DSM IV(Diagnostic and Statistical Manual of Mental Disorders), the “Bible” that made this diagnosis of sanity of mind possible, is completely unable – not only under the forensic aspects – to deal with the problems that it’s supposed to understand and solve: this psychiatry only causes confusion and aggravates the pathology of those who it should take care of. In Breivik’s case, the mistake is striking, but it’s a tell-tale of a submerged universe of mistakes, spreading like wild fire on a planetary scale, that could transform the USA (and not only), the cradle of DSM IV and V, in a open pit mental asylum. And what about Italy?

This article has been published by psychiatrist Domenico Fargnolion his website domenicofargnoli.com

Italian version

1 febbraio 2013

Finito il lavoro della Commisione presieduta da Marino: “lacune, anche gravi, fino a situazioni di degrado”. Ma non è colpa della 180: “le normative vigenti offrirebbero sufficienti possibilità di attuazione ed organizzazione dei servizi come previsto dalla legge Basaglia. Manca volontà politica e capacità amministrativa.

Quando le leggi sono state applicate in modo compiuto, hanno dato origine a modelli di eccellenza, elogiati anche a livello internazionale. Il problema é che nella maggior parte dei casi vengono applicate in modo difforme tra una regione e l’altra. Il risultato sono interventi socio-sanitari carenti, come l’apertura solo diurna e a orari ridotti dei Centri di salute mentale (Csm), Servizi ospedalieri di diagnosi e cura (Spdc) chiusi e che diventano luoghi di contenzione. E queste sono solo alcune delle criticità evidenziate dalla Commissione d’inchiesta sul Ssn presieduta dal senatore Ignazio Marino, nella bozza di relazione conclusiva sui servizi italiani di salute mentale, ora all’esame finale della Commissione.

In Italia, quando si tratta di salute mentale, si legge nel documento, prevalgono “lacune, anche gravi, fino a situazioni di degrado”. Eppure le normative vigenti offrirebbero sufficienti possibilità di attuazione ed organizzazione dei servizi, attraverso la filosofia di cura territoriale, individualizzata e centrata sui luoghi di vita delle persone, come delineata già dalla legge Basaglia.

Ma la disapplicazione della legge nazionale a livello regionale, accusa la Commissione, non sempre è “correlabile ad impedimenti economici”, ma anche a “disimpegno politico o incapacità amministrativa”. Tra le criticità più evidenti emerse, c’é l’apertura solo diurna dei Csm, spesso per fasce orarie ridotte, con conseguente ricorso alla domanda di posto letto ospedalieri negli Spdc; l’esiguità di interventi territoriali individualizzati ed integrati con il sociale, spesso limitati a semplici visite ambulatoriali ogni 2-3 mesi per prescrizioni farmacologiche, e l’offerta di ricoveri in cliniche private convenzionate con il Ssn, accessibili anche senza coordinamento con i Csm, che rappresentano l’espansione di modelli di assistenza ospedaliera al di fuori della cultura territoriale dei progetti obiettivo e dei piani per la salute mentale post legge 180.

Inoltre la relazione evidenzia come negli Spdc gran parte della cura sia affidata solo alla psicofarmacologia e la qualità della vita dei ricoverati sia spesso limitata ai soli bisogni primari. Si tratta di reparti chiusi, non solo per i ricoverati, ma anche per le associazioni di familiari, gli utenti e il volontariato. Anche per i servizi di neuropsichiatria infantile si è verificata una carenza e difformità di presenza dei posti letto ospedalieri e dei servizi territoriali sul territorio, con difficoltà di integrazione con i Csm dell’età adulta per il disagio nell’adolescenza, nonché l’uso di fasce di contenzione in alcuni reparti neuropsichiatria.

Per migliore la situazione, la Commissione avanza alcune proposte d’intervento. Quello più importante é di prevenire il disagio, affidando ai Csm il coordinamento. Attraverso il collegamento con i servizi di neuropsichiatria infantile e attraverso politiche sociali si può concretizzare la capacità di intercettare le problematiche emergenti sul nascere, al fine di riducendo la prevalenza di malattia, disabilità e cronicità, da cui origina anche lo “stigma” di chi è sofferente. Inoltre gli interventi sanitari e sociali devono essere più integrati e individualizzati per contenuti e risorse, attraverso una revisione dei Lea e l’istituzione di Drg di percorso, in cui l’intervento sanitario e sociale possa non essere più omologato per tipologia di struttura: l’approccio integrato cioé deve tradursi in una valorizzazione e remunerazione economica dell’intero percorso di cura del paziente, superando il concetto di rimborso per singola prestazione o per diagnosi.

La Commissione pensa a programmi di cura psicosociale, in cui possano essere rappresentati e coordinati interventi ambulatoriali, domiciliari, residenziali e ospedalieri secondo le esigenze individuali. Un approccio che consentirebbe di riqualificare tutte quelle situazioni di residenzialità “pseudo-riabilitativa”, rilevate sul territorio nazionale, che non si pongono obiettivi temporali. E qualora occorresse, potrebbero essere implementati o istituiti posti letto accessibili sulle 24 ore nei Csm territoriali, per ridurre il ricorso all’ospedalizzazione.

Adele Lapertosa

(da Quotidiano Sanità.it)

Commento: Il fallimento della cosidetta “legge Basaglia” e del modello assistenziale basato sulla psicofarmacologia che ha reso possibile la sia pur parziale attuazione della legge e lo smantellamento dei “manicomi lager” (gli OPG sono ancora aperti). Il fallimento della legge non consiste nel fatto che non è stata attuata ma esso è già contenuto nella impostazione ideologica di partenza che nega la malattia mentale: Breivik per lo psichiatra Dell’Acqua che di fatto prosegue la linea dell’intervento basagliano a Trieste, è un terrorista. La strage di Utoya sarebbe un delitto politico e non l’opera di uno schizofrenico. In quest’ultima valutazione si evidenzia la confusione fra categorie sociologiche e politiche e categorie psicopatologiche, in assenza delle quali non si può programmare nessun intervento efficace sul tema malattia mentale.

LA CELLA DI BREIVIK

Pubblicato da Vincenzo Borriello il 25 AGOSTO 2012 13:11

Più che di cella bisognerebbe parlare di miniappartamento per Breivik, il responsabile della strage di Utoya e Oslo nella quale morirono 77 persone e ne restarono ferite 200. La cella nella quale Breivik passerà i prossimi 21 anni farà invidia non solo a tanti nostri carcerati ma anche a chi vive in autentiche catapecchie pagando affitti scandalosi.

Norway killer Anders Breivik on hunger strike because he has no internet in jail

19 Jan 2013 22:00

The mass killer is also whining about not being allowed moisturiser and has complained that his coffee is not hot enough

Norwegian Police Investigators bring Anders Behring Breivik back to the scene of his July 22 rampage

VG/Scanpix

Norway massacre gunman Anders Breivik has gone on hunger strike … after moaning that he can’t log on to the web.

The mass killer, who slaughtered 77, also whined about not being allowed moisturiser, said his coffee was cold and bleated about not getting enough butter to spread on his bread,the Sunday People has revealed.

Evil Breivik, sentenced to 21 years for his July 2011 rampage, has stopped eating in protest over what he describes as his “inhumane” treatment at the jail.

He is believed to have lost around two stone in weight.

Anders Behring Breivik, makes a salute after arriving in the court room at a courthouse in Oslo. Breivik, who admitted killing 77 people in Norway last year — Anders Breivik makes a salute during his trial

Doctors at Ila Prison are monitoring the 33-year-old’s condition.

He first aired the complaints in a 27-page letter to Norwegian authorities in which he ranted over the way he was being treated.

Cell in the isolation wing of the Ila landsfengsel in Baerum just outside Oslo — Cell in the isolation wing of the Ila Prison

Getty

Breivik, who spends 23 hours a day in solitary confinement, claimed the tight security violated his human rights.

He demanded that restrictions on his access to computers were lifted and that he be allowed to surf the internet.

He also complained that his cell – which has areas for him to sleep, study and exercise – is poorly decorated with no picturesque view.

And he said that it was so cold he has to wear three layers of clothes.

The mass killer raged: “I highly doubt that there are worse detention facilities in Norway.”

It is believed that bosses at the prison, just outside Oslo, ignored the letter after it was sent two months ago, resulting in him going on hunger strike.

A prison source said: “By taking the extreme measure of not eating he is trying to get people to stand up and take notice. Breivik is very determined to get his conditions changed.”

He killed 77 people by blowing up a government building before gunning down innocent teenagers at their Youth Labour Party summer camp on Utoya island.

Breivik has not gone on a hunger strike

Breivik News 2013/01/21 Leave a comment

According to a British tabloid Breivik has gone on a hunger strike. I’m not sure if they’re making this up, but given the lack of letters and silence from the Norwegian media this is highly plausible. They report he has lost 28 pounds and that his situation is being monitored by doctors. It’s unclear if Norwegian law allows for Breivik to be force fed.

Assuming his demands won’t be met it’s my best guess that Breivik will fast until he dies. How long this will take depends on a couple of factors. My best guess is that the hunger strike started January 1, which means he’ll die late February or early March.

The psychological impact will be hard to predict, but it will most likely rattle the cage. I suspect that death by hunger strike has been Breivik’s intention all along in the case his right to free speech would be revoked, it’s one of the few ways to make a definite statement.

Update: 2013-01-22

I’ve received information from one of my sources that there is no hunger strike going on. This probably means Breivik’s original plan is in place to address his constitutional and human rights by juridical means, a somewhat lengthy process.

The Breivik Report
News and commentary on Commander Anders Behring Breivik of Knights Templar Europe.
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Update on Breivik’s mail situation

Breivik News, Breivik Prison Letters 2012/12/13 Comments: 2
Some months ago the media reported that Ila Fengsel had one person working full-time on processing Breivik’s mail. The obvious intend was to create public dismay about Breivik’s fan mail; at the tax payer’s expense. Combined with complaints about letters from Breivik published on the Internet, by yours truly, this resulted in increased restrictions on incoming and outgoing mail as of August 8, 2012.

It’s unclear if Breivik has a daily mail quota, or the available manpower to process letters has been reduced. Prison authorities are allowed to put a letter aside to be processed at a later date, and subsequently it appears hate mail and other irrelevant letters are given to Breivik directly, while letters from supporters are piled up. I draw this assumption based on Breivik’s complaint letter where he mentioned he has only received mail from haters and Christians after August 8.

In theory the prison can keep a letter in processing indefinitely, without giving notice. So far only one letter has been officially seized by the system, and one letter has been censored before it was given to Breivik.

Time for some good news, Breivik is once again receiving letters from supporters, though there is a 4 months backlog. Breivik has also been given more information about what information the system will censor, primarily content relating to politics and his ideology, and subsequently he has resumed writing letters.

It’s unclear how much time Breivik is allowed to spend behind his typewriter, prison authorities have hinted they won’t allow him to spend 8 hours a day writing letters and working on his books, so not everyone is going to get a quick response.

The man responsible for the unnecessarily cruel treatment of Breivik is prison director Knut Bjarkeid.

Breivik has complained about guards letting him freeze in his cell, guards waking him up several times a night by shining a flashlight into his face, being forced to strip naked and be searched at least once a day, being injured when handcuffs are placed around his wrists when he’s being moved between cells, and having been placed in complete isolation since the end of the trial.

The press makes light of this situation, but it’s pointless cruelty that serves no purpose and is reminiscent of the treatment of political prisoners in second world nations. It is unlikely to discourage ultra-nationalists from picking up arms because the alternative is genocide, and it will only strengthen the resolve of the anti-totalitarians that Cultural Marxism will continue to deviate from its self proclaimed righteousness and turn into an ideology that won’t be much different from Stalinism.

Psichiatria

Adan Lanza ha agito sotto gli effetti di psicofarmaci

21 dicembre 2012

Adam Lanza prendeva antipsicotici (TRADUZIONE DALL’INGLESE DI LORENZO FRUSTERI)

L’antipsicotico prescritto ad Adam Lanza ha una storia travagliata, tutta sua:

In questo momento tutto il paese è completamente assorbito dal dibattito sul controllo delle armi, sorto a causa del raccapricciante omicidio di 27 persone, soprattutto bambini, avvenuto alla Sandy Hook Elementary School lo scorso venerdì.

Le armi, tuttavia, potrebbero non essere il solo problema.

Il New York Magazine ha pubblicato un articolo nel quale si afferma che la presunta “Sindrome di Asperger” dell’omicida Adam Lanza sarebbe stata uno “specchietto per le allodole” per distogliere l’attenzione dal reale problema (le armi, naturalmente, non c’è bisogno di dirlo).

All’interno dell’articolo, però, si riporta che al ragazzo era stato prescritto il Fanapt, uno dei nomi generici usati per la sostanza Iloperidone, un antipsicotico atipico che funziona cambiando il funzionamento di alcune sostanze chimiche del cervello. Il Fanapt viene usato per trattare la schizofrenia e potrebbe anche essere impiegato per scopi non previsti nel foglio illustrativo.

Da Wikipedia:

L’Iloperidone, conosciuto anche come Fanapt, Fanapta, e in precedenza noto anche come Zomaril (…) è stato approvato dalla U.S. Food and Drug Administration (FDA) per l’utilizzo negli Stati Uniti il giorno 6 maggio 2009.

Come la maggior parte delle persone sa, i foglietti illustrativi che oggi sono acclusi a ogni farmaco sono scritti da avvocati; essi elencano ogni minimo effetto collaterale possibile, che potrebbe verificarsi anche per una piccolissima percentuale di coloro che assumono la medicina. Il foglietto illustrativo è quindi più un sistema per “pararsi il culo” (SIC) che una vera precauzione per il consumatore. Esso afferma che pensieri suicidari o di autolesionismo possono essere un effetto collaterale dell’Iloperidone.

Drugs.com riporta inoltre:

Effetti collaterali psichiatrici che includono irrequietezza, aggressività e fissazione sono stati frequentemente riportati. Ostilità, diminuzione della libido, paranoia, anorgasmia, stato confusionale, mania, catatonia, sbalzi d’umore, attacchi di panico, disturbo ossessivo compulsivo, bulimia nervosa, delirio, polidipsia psicogena, disturbo del controllo degli impulsi e depressione grave sono stati riportati raramente.

InfoWars scrive:

Come dimostrato nell’estratto del CCHR, i farmaci antipsicotici sono un tratto comune a coloro che compiono omicidi di massa con armi da fuoco, tuttavia nei mezzi di informazione principali non troverete nessuna richiesta di metterli al bando…

Che cosa ha fatto sì che Adam Lanza abbia sparato a sua madre in faccia, abbia poi sparato a 20 bambini e 6 adulti innocenti e poi a se stesso? Forse non lo sapremo mai. Incolpare semplicemente una prescrizione medica che avrebbe dovuto aiutarlo è sbagliato; incolpare semplicemente i videogiochi è sbagliato; incolpare semplicemente il suo stato mentale è sbagliato. Dare la responsabilità di quelle 27 morti ad un’arma che da sola non può fare niente, è certamente sbagliato.

Lanza aveva problemi: secondo alcune fonti, sua madre stava apparentemente cercando di farlo accedere a una struttura che potesse aiutarlo, ma lui non voleva andarci. Secondo altre, la madre cercava di spingerlo ad uscire di casa per trovare un lavoro o andare al college.

Forse non conosceremo mai la verità.

Ma torniamo al farmaco; da Business Insider:

Fanapt è stato oggetto di una relazione di Bloomberg nel momento in cui ha superato i controlli dopo essere stato in precedenza rigettato. Ci si potrebbe chiedere perché non sia stato approvato, la prima volta.

Ci sono molte ragioni, alcune delle quali hanno a che fare con aziende molto competitive che operano in un mercato molto competitivo.

La ragione principale del rigetto è stata che il farmaco causava così gravi problemi cardiaci da fare sensazione.

Tuttavia, e questo riveste una molto maggiore importanza, il Fanapt è uno dei numerosi farmaci dei quali la FDA ha chiaramente evidenziato la capacità di generare nelle persone esattamente l’effetto opposto di quello desiderato: cioè, per essere espliciti, indurre, piuttosto che inibire, la psicosi e l’aggressività.

Nella realtà il Fanapt era stato abbandonato dal suo primo produttore, rilevato da un altro, poi inizialmente rigettato dalla FDA, e successivamente ripescato e prodotto in larga scala. L’effetto collaterale avverso viene definito “infrequente” ma esiste ancora, e non può essere ignorato.

La reazione che i farmaco induce in alcune persone, richiama alla memoria il caso di Jeffrey R. MacDonald, un Berretto Verde (corpi speciali dell’esercito degli Stati Uniti, n.d.t.) che sgozzò tutta la sua famiglia e poi inventò una storia incolpando un gruppo di “hippy drogati” dediti al saccheggio e alla rapina.

MacDonald, tuttavia, aveva in circolo l’Eskatrol, un’anfetamina per perdere peso, che da allora è stata proibita in parte anche a causa dei suoi effetti collaterali di comportamento psicotico e aggressività.

Questi farmaci non sono i soli a causare effetti opposti a quelli desiderati. Molti antidepressivi sono prescrivibili solo ad adulti, per esempio, poiché nei bambini causano, invece che eliminare, la depressione.

FANAPT (Iloperidone)

(Le parole o frasi sottolineate forniscono utili link alle informazioni di Wikipedia.org; muovendo il mouse sopra di esse, inoltre, si ottengono utili definizioni dei termini medici.) Il Fanapt può causare comportamento violento/aggressivo (frequente). Questo farmaco può inoltre causare i seguenti sintomi, correlati a comportamento violenti/aggressivo:

– Iperattività (non comune)

– Problemi di controllo degli impulsi (non comune)

– Mania (non comune)

– Irrequietezza (non comune)

Informazioni di Medical Source

Le parole evidenziate indicano sintomi correlati a comportamento aggressivo/violento.

Effetti collaterali psichiatrici riportati con frequenza comprendono: irrequietezza, aggressività e fissazione.

Ostilità, diminuzione della libido, paranoia, anorgasmia, stato confusionale, mania, catatonia, sbalzi d’umore, attacchi di panico, disturbo ossessivo compulsivo, bulimia nervosa, delirio, polidipsia psicogena, disturbo del controllo degli impulsi, e severa depressione sono stati riportati non frequentemente. Sono stati riportati anche effetti collaterali relativi al sistema nervoso, quali stordimento (fino al 20%), sonnolenza, (fino al 15%), disturbo extrapiramidale (fino al 5%), tremori (3%), e letargia (fino al 3%). Parestesia, iperattività psicomotoria, irrequietezza, amnesia, e nistagmo sono stati riportati non frequentemente. La sindrome delle gambe senza riposo è stata riportata raramente.

EFFETTI COLLATERALI DA OSSERVARE

Prestate attenzione ai seguenti effetti collaterali e datene comunicazione al vostro medico curante, qualora dovessero svilupparsene alcuni:

– Battito cardiaco alterato, palpitazioni, debolezza, senso di svenimento, stordimento o perdita di conoscenza (segno di una grave condizione chiamata Sindrome del QT Lungo o torsades de pointes, nella quale si hanno battiti cardiaci irregolari);

TEST DI LABORATORIO E DIAGNOSTICI

Se si dovessero manifestare alcuni sintomi, chiedete al vostro medico curante se avete bisogno dei seguenti test di laboratorio o di altre analisi diagnostiche (nel caso in cui non li abbiate già fatti):

– Conto dei globuli bianchi e analisi del sangue complete

– Analisi del fattore di coagulazione – per coloro che abbiano segni di scarsa coagulazione, come contusioni anormali, o come sanguinamenti dalle gengive, dal naso, nel tratto digestivo, dalla vagine (nelle donne), senso di svenimento, stordimento, perdita di conoscenza o rash

– ECG se si sviluppano battiti anormali (accelerati, rallentati o irregolari)

– Elettroliti, magnesio, potassio e glucosio: controllarli prima di cominciare il trattamento e poi controllarli regolarmente

Referenze

Informazioni del prodotto. Fanapt (iloperidone). Anonymous Vanda Pharmaceuticals Inc, Rockville, MD.

Counterterrorism, politics, religion, …

« Bikers Turn Out to Protect Newtown Mourners from Left-Wing Westboro Cult | Main| Pope says future of mankind at stake over gay marriage »

DECEMBER 21, 2012

Adam Lanza Taking Antipsychotics

Via Business Insider, hat tip SBY News:

The Antipsychotic Prescribed To Adam Lanza Has A Troubled History All Its Own:

By now the whole country is fully embroiled in the Gun Control debate, spurred by the grisly murder of 27 people, mostly kids, at the Sandy Hook Elementary school last Friday.

Guns might not be the only problem though.

New York Magazine wrote a pieceabout shooter Adam Lanza’s supposed “aspergers” syndrome as a “red herring” meant to distract from the real problem (guns, of course, the subject goes without mentioning).

Inside the piece though they report the boy was prescribed Fanapt, a controversial anti-psychotic medicine.

The article uses the term “controversial” to describe Fanapt, one generic name used for the drug Iloperidone which is an atypical antipsychotic medication that works by changing the effects of chemicals in the brain. Fanapt is used to treat schizophrenia andmay also be used for purposes not listed in the medication guide.

From Wikipedia:

Iloperidone, also known as Fanapt, Fanapta, and previously known as Zomaril, … It was approved by the U.S. Food and Drug Administration (FDA) for use in the United States on May 6, 2009.
As most people know, the medication guides are written by lawyers and included with all medications these days. They list every possible side affect that could ever happen even to a tiny percent of those taking the medication. The medication guide is more of a ‘cover your butt’ for the drug companies than it is a caution for the consumer. It does say that thoughts about suicide or hurting yourself can be a side affect of Iloperidone.

Drugs.com also reports:

Psychiatric side effects including restlessness, aggression, and delusion have been reported frequently. Hostility, decreased libido, paranoia, anorgasmia, confusional state, mania, catatonia, mood swings, panic attack, obsessive-compulsive disorder, bulimia nervosa, delirium, polydipsia psychogenic, impulse-control disorder, and major depression have been reported infrequently. (hat tip Economic Policy Journal)

InfoWars writes:
As the except from CCHR below demonstrates, anti-psychotic drugs are a hallmark of mass shooters, but you won’t see any call in the mainstream media to see them banned, …

What caused Adam Lanza to shoot his mother in the face, to shoot 20 innocent young children and 6 innocent adults and then shoot himself? We may never know. To blame it on a prescription alone that was supposed to help him is wrong; or to blame it on video games alone is wrong; to blame it on his mental condition alone is wrong. To blame the 27 deaths on a a gun that on it’s own can do nothing, is certainly wrong.

Lanza had problems, his mother was apparently trying to get him into a facility that could help him, and he did not want to go, according to some reports. Other reports have the mother trying to push him out of the house to get a job or attend college.

We may never really know the truth.

Back to the drug from Business Insider:

Fanapt was the subject of a Bloomberg report when it passed regulators, after previously getting the “nonapproval” stamp. Why wasn’t it approved, you might ask?

There are many reasons, some of which have to do with competing entities in a competitive market.

The main cited reason for the rejection was that it caused severe heart problems in enough patients to cause a stir.

Maybe more importantly, though, Fanapt is one of a many drugs the FDA pumped out with an ability to exact the opposite desired effect on people: that is, you know, inducing rather than inhibiting psychosis and aggressive behavior.

[snip]

In fact, Fanapt was dropped by its first producer, picked up by another, initially rejected by the FDA, then later picked up and mass produced. The adverse side-effect is said to be “infrequent,” but still it exists, and can’t be ignored.

The reaction invoked by the drug in some people is reminiscent of the Jeffrey R. MacDonald case, where a Green Beret slaughtered his entire family and then fabricated a story about a marauding troop of “hopped up hippies”.

MacDonald though, had Eskatrol in his system, a weight-loss amphetamine that’s since been banned in part for its side effects of psychotic behavior and aggression.

These drugs are not the only ones that can cause the opposite of their desired effect. Several anti-depressant medications are also restricted to adults, for the depression they inspire in kids rather than eliminate.

Fanapt (iloperidone)

Side Effect Search

Underlined words or phrases provide helpful links to information in wikipedia.org and when moused over often give helpful definitions of the medical terms. Keywords

Fanapt may cause aggressive/violent behavior (frequent).This drug may also cause the following symptoms that are related to aggressive/violent behavior:

Hyperactivity (uncommon)
Impulse control problems (uncommon)
Mania (uncommon)
Restlessness (uncommon)

Medical Source Information
Yellow highlights indicate symptoms related to aggressive/violent behavior.Psychiatric side effects including restlessness, aggression, and delusion have been reported frequently. Hostility, decreased libido, paranoia, anorgasmia, confusional state, mania,catatonia, mood swings, panic attack, obsessive-compulsive disorder, bulimia nervosa,delirium, polydipsia psychogenic, impulse-control disorder, and major depression have been reported infrequently.Nervous system side effects including dizziness (up to 20%), somnolence (up to 15%),extrapyramidal disorder (up to 5%), tremor (3%), and lethargy (up to 3%) have been reported.Paraesthesia, psychomotor hyperactivity, restlessness, amnesia, and nystagmus have been reported infrequently. Restless legs syndrome has been reported rarely.

Side Effects to Watch
Watch closely for the following side effects and notify your physician immediately should any of these develop:

Abnormal heart rate, fluttering in the chest, weakness, faintness, dizziness or loss of consciousness (signs of a serious condition called “torsade de pointe or QT prolongation” in which irregular heartbeats occur)

Lab and Diagnostic Tests
If certain symptoms develop, ask your physician whether you need the following lab tests or other diagnostic tests (if you’ve not already had them):

Monitor white blood cell count, complete blood count and complete blood count
Blood tests to assess normal clotting – in people who develop signs of bleeding such as abnormal bruising or signs of bleeding including bleeding from the gums, nose, digestive tract, vagina (females), faintness, dizziness, loss of consciousness, or rash
EKG – if abnormal heartbeats (rapid slow or irregular) develop
electrolytes, magnesium, potassium and glucose – check before starting treatment and then periodically

References

Product Information. Fanapt (iloperidone). Anonymous Vanda Pharmaceuticals Inc, Rockville, MD.

Psichiatria

Psicofarmaci e violenza

Neuroleptic Drugs and Violence

Catherine Clarke SRN, SCM, MSSCH, MBChA.

and Jan Evans MCSP. Grad Dip Phys.

August 19^th, 2012

Introduction

We address the fact that the treatment for Severe Mental Illness (SMI) is neuroleptic medication. One has to give significant thought about the involvement of neuroleptic medications with the tragic circumstances of individuals who have perpetuated a progressive catalogue of catastrophic actions, and the many victims and their families who so sadly are caught up in such tragedies.

It is established that there is an increased risk of violence by people with a mental health diagnosis. A greater risk of violent behaviour (27.6%) has been found for patients who commit substance abuse, compared to non-abusers (8.5%). For patients with schizophrenia, 13.2 % committed at least one violent offence, compared with 5.3% of the general population.¹

Violence is reported with command hallucinations: 48% experienced harmful or dangerous actions and this increased to 63% in medium secure units and was significantly higher, 83%, in the forensic population.²

People who are classified as SMI i.e. with schizophrenia or bipolar often experience violent incidents following a diagnosis of SMI, even though they don’t consume alcohol or use street drugs, nor having a past history of violence or command hallucinations to harm others.

Our purpose of this document is to provide a referenced explanation of how neuroleptic medications are a potential cause of violence. We take a physiological perspective concerning pharmacogenetic variants and the disruption of neurotransmitters. In Part 1 we discuss what is known about Neuroleptics and Neurotransmitters; in Part 2, the Neuroleptic Disruption of Neurotransmitters

Part 1

The first part of this document has the following structure:

· Violence

Neuroleptic Adverse Effects on Behaviour
Serotonin Disruption
Noradrenaline/Norepinephrine Disruption
Acetylcholine Disruption including Neuroleptic Malignant Syndrome and Organophosphate Poisoning

· Neuroleptic Withdrawal Adverse Effects on Behaviour

· Neurotransmitter Functioning and Behaviour

· Increased Prescribing of Neuroleptics as a Risk for Increased Violence

Violence

This is an important issue. In three acute psychiatric units in Australia it was reported: “58 % of the incidents were serious violent incidents.”³ In an attempt to address psychiatric violence in the UK, the National Institute for Health and Clinical Excellence (NICE) has a full clinical guideline: Violence. The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.⁴ Although this addresses many issues, it omits the following potential causes of violence:

Neuroleptic medications – due to neuroleptic disruption of neurotransmitter circuits such as dopamine, serotonin, norepinephrine/noradrenaline and acetylcholine.
Pharmacogenetics – the issue of inefficient neuroleptic metabolising.

Adverse Effects on Behaviour of Neuroleptics

Neuroleptic toxic adverse reactions are related to behavioural changes such as akathesia, which is known to be a predisposing factor to violence⁵and was formally recognised in the late 1970s.⁶

The symptoms of akathisia, an extreme, involuntary internal physical and emotional restlessness, includes restlessness, agitation and irritability.

When there is an existing precondition of akathisia, any perceived untoward disrespectful attitudes or verbal communications can trigger violence. When patients are agitated or irritable, they are less able to cope with perceived disrespect and are more prone to respond violently.

A marked increase of violence has occurred with patients prescribed moderately high-doses of haloperidol,⁷ and with Asian patients clozapine played a role in causing aggression and disruptive behaviour.⁸ Both the older ‘typical’ and the newer ‘atypical’ neuroleptics are associated with adverse behavioural reactions in a study reporting that “the newer antipsychotics did not reduce violence more than perphenazine.”⁹

Chart Depicting Toxic Behavioural Effects for Typical Neuroleptics:

Typical Neuroleptics	Adverse Reactions Related to Violence
Clopixol	Agitation & akathisia
Haloperidol	Restlessness, agitation and violence
Stelazine	Restlessness
Sulpiride	Restlessness & akathisia

^{Refs 7, 10 &11}

Chart Depicting the Toxic Behavioural Effects for Atypical Neuroleptics:

Atypical Neuroleptics	Adverse Reactions Related to Violence
Abilify	Restlessness, agitation and akathisia
Amisulpride	Agitation
Clozaril	Akathisia and agitation
Olanzapine	Restlessness and agitation
Palperidone/Invega	Akathisia and aggression
Quetiapine	Akathisia and irritability
Risperidone	Agitation
Sertindole	Akathisia
Zotepine	Akathisia

^{Ref 10}

Observations in prison have also associated neuroleptic treatment with increased aggressive behaviour. Inmates were better able to control their aggression until they were prescribed neuroleptics and then the aggression rate almost tripled.¹²

Neuroleptic Withdrawal Adverse Effects on Behaviour

There is also the issue of violence experienced during withdrawal. Irritability and agitation is reported in association with neuroleptic withdrawal,¹³ and a direct reference links akathisia following the withdrawal of a depot in an inpatient setting.¹⁴ Irritability, agitation and akathisia need to be recognised as reactions to neuroleptic withdrawal.

In order to prevent violence in association with akathisia and withdrawal, this process needs to be undertaken by a professional or lay-person who understands the potential problems and can therefore guard against unwittingly appearing at all antagonistic to the patient.

Neurotransmitter Functioning and Behaviour

Fundamentally, human behaviour is determined by neurotransmitter functioning and “A rich literature exists to support the notion that monoamine (i.e. serotonin, dopamine, and norepinephrine) neurotransmitter functioning is related to human aggressive behaviour.”¹⁵

Dopamine, serotonin and all other neurotransmitter circuits are interdependent and any disturbance in one will result in an imbalance in them all, disrupting normal functioning. Jackson’s First Law of Biopsychiatry states: “For every action, there is an unequal and frequently unpredictable reaction.”¹⁶

Chronic neuroleptic treatment causes unpredictable behavioural reactions due to dysregulation and disruptions between dopamine, serotonin and acetylcholine neurotransmitters.

Neuroleptics and Serotonin Disruption

Some neuroleptics are known as serotomimetic drugs, affecting serotonin receptors – some block the receptors and some make them more active. “There are 14 different types of serotonin receptors that may be targeted by neuroleptics, with risperidone, clozapine, olanzapine, quetiapine and clopixol especially affecting the serotonin 5-HT2 receptor.”¹⁷

Mental status changes occur in Serotonin Syndrome. This is caused by neuroleptic drugs due to serotonin toxicity.

Animal research indicates that serotonin disruption is associated with increased violence. Reduced levels of a specific serotonin metabolite (5-HIAA) in cerebrospinal fluid has been linked with increased aggression in both dogs and male rhesus macaques^18-19 and low concentrations of 5-HIAA in different cultures have been consistently reported to be associated with impulsive destructive behaviours, aggression and violence.²⁰

Since “Impulsive violence is closely linked to serotonergic function and to several brain regions”²¹ and since impulsivity is also linked with both low and high serotonin levels it is difficult to know which of these changes play the most important role in treatment emergent violence.”¹⁷

The reciprocal interaction between the dopaminergic and serotonergic systems disturbed by either dopaminergic blockers or serotonergic enhancers leads to the disruption of homeostasis.²²Although the serotonin system and its interactions with other neurotransmitters are complex and full information is difficult to find, there are clear research papers, which show that serotonin and aggression are related.

Chart depicting Neuroleptic Serotonin Disruption associated Adverse Toxic Behavioural Effects:

Akathisia	Irritability
Suicidality	Violence
Arson	Aggression
Violent Crime	Self Destructiveness
Impulsive Acts	Agitation
Hostility	Violent Suicide
Argumentativeness

^{Ref 23 & 24}

Neuroleptics and Noradrenaline/Norepinephrine Disruption

Neuroleptics affect the norepinephrine neurotransmitter and akathisia induction with haloperidol is known to be associated with increased noradrenaline turnover.^25- ²⁶

Neuroleptics and Acetylcholine Disruption

An important function of the acetylcholine neurotransmitter is the control of psychological defence mechanisms including fight or flight responses. Such responses are impulsive and naturally include aggression and violence.

In varying degrees, all neuroleptic drugs have anticholinergic properties. This means that they block and cause disruption to the acetylcholine neurotransmitters. The body compensates and responds by making and releasing more acetylcholine.²⁷

Acetylcholine Disruption and Increased Violence

Aggressive responses such as defensive rage and violence have been linked with excessive acetylcholine in animals^{28 –30} and a relative acetylcholine increase is associated with neuroleptic drugs due to the disruption of the dopamine-acetylcholine equilibrium.^31-32

Since excessive acetylcholine is linked with aggression and violence in animals, it is likely that neuroleptic induced acetylcholine abundance triggers aggression and violence in humans.

Neuroleptic → Disrupted dopamine-acetylcholine equilibrium → Relative acetylcholine increase → Aggression/Violence.

Neuroleptic Malignant Syndrome and Organophosphate Exposure

Neuroleptic Malignant Syndrome (NMS) is an adverse effect of neuroleptics, a potentially fatal condition with up to 76% mortality rate. Symptoms of NMS include aggression, agitation and violence.^{27 & 33} New research associates NMS with elevated acetylcholine.³⁴

Organophosphate chemicals form the basis of many insecticides, herbicides and nerve gases. They block the action of the body’s acetylcholinesterase enzyme, which breaks down acetylcholine so it may be processed and recycled. Excessive acetylcholine accumulates in the nervous system if the action of this enzyme is blocked.

Prolonged and repeated exposure to Organophosphates results in Chronic Organophosphate-Induced Neuropsychiatric Disorder (COPIND) e.g. in farmers who handle pesticides, due to chronic Organophosphate Poisoning (OP). COPIND behavioural symptom changes include: Hostility, Anger, Aggression and Violence.^35-36 Since OP results in excessive acetylcholine, which is linked with aggression and violence in animals, the behavioural changes in COPIND are highly likely caused by excessive acetylcholine.

The link between Neuroleptic Malignant Syndrome and Organophosphate Poisoning

The symptoms of NMS and OP are similar. In both NMS and OP the replication of symptoms is due to autonomic instability and stems from disruption of the acetylcholine circuits and transmitters of the Autonomic Nervous System, involved with vital involuntary functions.

Autonomic Instability includes profuse sweating, high blood pressure, low blood pressure, respiratory distress, drooling, urinary or faecal incontinence, increased and

decreased heart rate.²⁷

Chart Depicting the Symptom Similarities of NMS and OP

Neuroleptic Malignant Syndrome	Organophosphate Poisoning
Autonomic nervous system disturbance	Autonomic Instability
Aggression, agitation and violence	Aggression
Muscle rigidity	Paralysis, Dystonia, Cranial nerve palsy and polyneuropathy
Muscle breakdown	Weak respiratory and limb muscles
Coma, alterations of consciousness	Loss of consciousness
Confusion	Dementia, psychosis, anxiety, depression
Fever	Seizures

Refs 27 & 33

Conclusion: Organophosphates, Neuroleptics and Violence

Organophosphate Poisoning results in over stimulated acetylcholine neuro-circuits and systems. The action of neuroleptics is similar. It is generally accepted that Organophosphate Poisoning results in behavioural changes including violence.

Despite research to show that neuroleptics are associated with disrupted acetylcholine, it is not yet generally accepted that neuroleptics are a potential cause of violence.

Antipsychotic/neuroleptic drugs have strong anti-cholinergic properties and long-term use causes behavioural changes, which replicate the same behavioural changes occurring in chronic Organophosphate Poisoning:

“This adaptation (to psychiatric drugs – author input) replicates the effect of organophosphate poisoning whether by nerve gas, by insecticide, or by anti-Alzheimers pharmaceuticals by over stimulating acetylcholine circuits of the brain.”²⁷

Increased Prescribing of Neuroleptics

There has been a distinct increase in neuroleptic medications, prescribed as part of treatment for mental health issues.

In the UK between 1998 and 2010, Neuroleptic drug prescriptions increased by an average of 5.1% every year.³⁷Over twelve years, this is a total increase of 60%.

In England, the approximate number of neuroleptic and depot (injection) prescriptions used by outpatients:

2008 – 7.0 million

2009 – 7.3 million

2010 – 7.6 million

2011 – 7.9 million³⁸

However, due to confidentiality, the data for the number of neuroleptic prescriptions in inpatient settings is not made available. So the actual total increase of neuroleptic prescriptions in the UK is unknown.

Increased Prescribing as a Risk for Increased Violence

As outlined above, neuroleptics are a possible cause of violence. With ever increased prescribing of neuroleptic medications, it is reasonable to expect an increased amount of violent behaviour amongst those with a severe mental health diagnosis.

Since neuroleptic prescriptions are increasing by 300,000 per year in the UK, it is hypothesized that the rise in violence for neuroleptic-treated patients will escalate, whether in the community or in acute wards, secure units, prisons or outpatient units.

Part 2. Neuroleptics and Pharmacogenetics

The second part of this document has the following structure:

Introduction to Pharmacogenetics regarding Neuroleptics
Pharmacogenetics and Ethnic Black Populations
Black Populations and Psychiatric Intensive Care Units
Black Populations, detention under the UK Mental Health Act and UK Community Treatment Orders
Pharmacogenetics as an explanation for Black Over-representation in

Psychiatric Intensive Care Units, detentions within the UK Mental

Health Act and Community Treatment Orders

Introduction to Pharmacogenetics with regards to Neuroleptics

Pharmacogenetics is the science of how drugs are broken down and used – i.e. metabolised in the body, mainly in the liver, by the genetically diverse Cytochrome P450 (CYP450) enzyme system and other drug metabolising systems. There are many CYP450 variants that affect therapeutic efficacy and inefficacy of medications.

Extensive Metabolisers are efficient metabolisers, whereby side-effects do not build up. Poor Metabolisers are inefficient metabolisers that have no metabolising activity whatsoever; this means that drug toxicities do build up and cause side effects. Intermediate Metabolisers have approximately 50% drug metabolising capacity and produce lesser side-effects than Poor Metabolisers.³⁹ Ultra Rapid Metabolisers/ Hyperinducers have higher than normal rates of drug metabolism; Those medications which are classified as prodrugs are inactive until metabolised in the body, therefore Ultra Rapid Metabolisers are at increased risk of drug-induced side effects due to increased exposure to prodrug active drug metabolites.⁴⁰

Neuroleptic drugs are metabolised through CYP450 enzymes e.g.CYP450 1A2, 2D6 and 2C19. A single neuroleptic can necessitate a combination of CYP450 enzymes for metabolisation.

All SMI patients who are Poor and/or Intermediate Metabolisers of neuroleptics, and Ultra Metabolisers of neuroleptic prodrugs; e.g. paliperidone, the active metabolite of risperidone; will inevitably suffer neurological and behavioural changes due to toxicities incurred from the inability to metabolise neuroleptics efficiently. Polypharmacy compounds the toxicities.

CYP450 1A2 Metabolising Pathway and Neuroleptics

CYP450 1A2 enzyme pathway has many variants and metabolises olanzapine and haloperidol and is the major metabolising enzyme for clozapine.

CYP1A2*1C and *1D Poor Metabolisers have been associated with increased clozapine exposure and adverse reactions.⁴¹ CYP1A2*1K is also Poor Metaboliser genotype.⁴²

In one study, Asian patients who were prescribed clozapine, experienced aggression and disruptive behaviour who, following clozapine discontinuation, had marked improvement.⁸ The genotype of the Asian patients in the study is unknown, however since 25% of Asians have CYP1A2*1C Poor Metaboliser genotype,⁴³it is possible these patients were either CYP1A2*1C, *1D or *1K or a combination of these Poor Metaboliser genotypes.

Additionally15-20% of Asians are Poor Metabolisers for CYP2C19 and 2% are Poor Metabolisers for CYP2D6.⁴⁴CYP2C19 and CYP2D6 metabolise clozapine as well as CYP1A2; any of these combinations are possible and could have predisposed to disruptive behaviour.

CYP450 2D6 Metabolising Pathway and Neuroleptics

75% of all psychotropic drugs, including neuroleptics, are metabolised via CYP450 2D6.⁴⁵ CYP450 2D6 is a highly variable enzyme with a significant percentage of the population being Poor, Intermediate or Ultra Metabolisers and is linked with a poor therapeutic response and adverse reactions.

Violence in relation with serotonin toxicity/akathisia has been linked with pharmacogenetic CYP450 2D6 drug metabolising variants.⁴⁶

Pharmacogenetics and Ethnic Black Populations

Due to genetic variations there is higher incidence of Poor Metaboliser and Ultra Metaboliser status in Black populations, compared with White and Asian populations for the CYP 450 2D6 pathway. “The prevalence of poor metabolizers in Black populations has been estimated from 0 to 19%, compared with consistent reports of poor metabolizer status in Caucasians (5–10%) and Asians (0–2%).”⁴⁷

Recalling that 75% of neuroleptic medications are metabolised via CYP450 2D6, the following table shows the variation of metabolising ability in black ethnic populations for CYP450 2D6.

	Poor Metabolisers	Ultra Metabolisers
South Africans	18.8%
Nigerians	8.6-8.3%
Ghanaians	6%
African – American	3.9%	2.4%
Zimbabwean	2%
Tanzanian	2%
American Black	1.9%
Ethiopians	1.8%	29%

^Ref⁴⁸

29% of Ethiopians and 2.4% of North African Americans are Ultra Metabolisers via CYP450 2D6 pathway.⁴⁸ Furthermore, 10-20% of Africans are Poor Metabolisers and 5% are Ultra Metabolisers via CYP450 2C19.⁴⁹

Many prescription medications can lead to “serious mental change.”⁵⁰ Since black populations statistically have difficulty in metabolising general and psychotropic medications and cannabis via the CYP450 pathways, this factor could contribute to BME groups living in the UK who are more likely to be diagnosed with a Mental Health problem and admitted to hospital.⁵¹

Psychiatric Intensive Care Units and Over-representation of Black Populations

In UK Psychiatric Intensive Care Units (PICU), there is clear over-representation of black ethnic patients.⁵² Another study showed fifty-five percent of PICU admissions came from ethnic minorities(compared with 25.6% of total hospital admissions and 20.9%of the local catchment area population aged between 16 and 65years).⁵³

“TypicalPICU patients are male, younger, single, unemployed, sufferingfrom schizophrenia or mania, from a Black Caribbean or Africanbackground, legally detained, with a forensic history. The mostcommon reason for admission is for aggression management.”⁵⁴

UK Mental Health Act Detentions and Over-representation of Black Populations

There is also a disproportionately large representation of Black Minority and Ethnic (BME) origin when considering those who are legally detained under the UK Mental Health Act.

The proportion of black and black British people legally detained rose by 9.7%, with a 9% rise in the number of Asian or Asian British and mixed-race people detained for treatment, compared to a 0.3% rise for the overall number of people detained from 2007/8 to 2008/9. This disparity grew and 53.9% of black/black British inpatients spent time compulsorily detained, as did almost half of mixed-race inpatients and over 40% of Asian/Asian British inpatients, compared with 31.8% of all psychiatric inpatients who spent some time detained during the year.⁵⁵

UK Community Treatment Orders and Black Populations

Legal UK Community Treatment Orders are enforced when patients have received mental health ‘treatment’ i.e. neuroleptics and history of violence; BME Groups have more Community Treatment Orders than white populations.⁵⁶

“There is a possible relationship for psychiatric in-patients between compulsory detention, disturbed behaviour, depot medication and being black, which is not satisfactorily explained by diagnosis alone.”⁵⁷

The higher incidence of mental health problems in black populations is most likely due to the higher incidence of Poor, Intermediate and Ultra Metabolisers and the associated problems with metabolising medications.

Synopsis

Neuroleptics can be a cause of violence due to neurotransmitter disruption.

Violence must be considered not simply as an indication of how deeply schizophrenia /bipolar illness can worsen, but as an adverse effect of neuroleptic treatment.

People who are inefficient metabolisers are likely to suffer more severe adverse effects and become violent or aggressive.

BME populations have a higher incidence of inefficient metabolisers and as such a higher incidence of violence leading to PICU admissions and Mental Health Act detentions.

However whatever the nationality, when individuals are Poor and Intermediate Metabolisers and Ultra Rapid Metabolisers for prodrugs, the impact of neuroleptics in triggering akathisia, aggression or irritability can trigger violence indiscriminately.

Conclusion

There is a larger incidence of violence in people with a severe mental health diagnosis than in the general population. The severely mentally ill are invariably treated with neuroleptic medication which itself can be the cause of violence since neuroleptic medications disrupt neurotransmitter functions. This disruption of neurotransmitter functioning can precipitate violent behaviour. Withdrawal of neuroleptic medication – due again to the disruption of neurotransmitters – is also associated with violence.

Pharmacogenetics show that the some people are unable to metabolise neuroleptic medication and this inability can result in further disruption of neurotransmitter functioning with a likelihood of increased violence.

The inability to metabolise neuroleptic medication is particularly prevalent in BME populations. As a consequence this population experience more violence which is confirmed in practice by an over representation of BME individuals, both on Psychiatric Intensive Care Units (PICUs) where a common reason for admission is aggression, and the use of Mental Health Act detentions and Community Treatment Orders.

With the trend towards increased prescribing of neuroleptic medications, a level of increased violence can be anticipated for the future.

There is the possibility of ameliorating the presence of violence in the severely mentally ill by ensuring pharmacogenetics is more fully recognised as a significant factor, and that genotype testing is adopted in order to assess the ability of the individual to metabolise neuroleptic medication. Without this testing,

much of the violence in psychiatry can be laid at the door of psychiatrists and the pharmaceutical companies.

References:

Ref 1 Fazel S, et al, (2009) http://www.ncbi.nlm.nih.gov/pubmed/19454640

Ref 2 Birchwood et al. (2011)

http://www.biomedcentral.com/1471-244X/11/155/

Ref 3 Owen C. et al, (1998) http://ps.psychiatryonline.org/article.aspx?Volume=49&page=1452&journalID=18

Ref 4 http://www.nice.org.uk/nicemedia/live/10964/29715/29715.pdf

Ref 5 Crowner ML, et al (1990) http://www.ncbi.nlm.nih.gov/pubmed/1973544

Ref 6 GB. Leong, M.D. and JA Silva, M.D. (2003)

http://library-resources.cqu.edu.au/JFS/PDF/vol_48/iss_1/JFS2002173_481.pdf

Ref 7 John N. Herrera et al (1998)

http://psychrights.org/research/Digest/NLPs/RWhitakerAffidavit/HerreraNeurolepticsandViolence.PDF

Ref 8 KA.Mansour, C.Willan and J.Follansbee (2003) http://bapauk.com/doc/Deteriorationofpsychosisinducedbyclozapine_41.doc

Ref 9 Jeffrey W. Swanson et al, (2008) http://bjp.rcpsych.org/content/193/1/37.full

Ref 10 Drug Monographs, Prescribing information and UK NICE Guidelines 2007 – 2012.

Ref 11 Jerome L. Schulte, (1985) http://psychrights.org/research/Digest/NLPs/RWhitakerAffidavit/Schulte.PDF

Ref 12 D.G. Workman and D.G. Cunningham (1975) page 65

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2274756/pdf/canfamphys00332-0065.pdf

Ref 13 MIND http://www.mind.org.uk/help/medical_and_alternative_care/making_sense_of_coming_off_psychiatric_drugs

Ref 14 Theodore Van Putten, (1975)

http://psychrights.org/research/Digest/NLPs/RWhitakerAffidavit/VanPuttenManyFacesofAkathisia.PDF

Ref 15 Berman ME, Coccaro EF. “Neurobiologic correlates of violence: relevance to

criminal responsibility.” Behav Sci Law. 1998 Summer;16(3):303-18. Review.

http://www.ncbi.nlm.nih.gov/pubmed/9768463

Ref16 Jackson, Grace E. MD, Appendix D, Transcript of

“What Doctors May Not Tell You About Psychiatric Drugs”

Public Lecture, Centre for Community Mental Health – UCE Birmingham June 2004

Ref 17 Jackson Grace E. (2005) Rethinking Psychiatric Drugs: A Guide for Informed Consent. Bloomington, IN: Author House.

Ref18 Reisner I, et al, (1996) http://www.ncbi.nlm.nih.gov/pubmed/8861609

Ref 19 Mehlman P, et al (1990) http://www.ncbi.nlm.nih.gov/pubmed/7522411

Ref 20 Brown GL & Linnoila MI (1990) http://www.ncbi.nlm.nih.gov/pubmed/1691169

Ref 21 Muller JL et al (2004) http://www.ncbi.nlm.nih.gov/pubmed/15570500

Ref 22 Odagaki (2009) http://www.benthamscience.com/cds/samples/cds4-1/0013CDS.pdf

Ref 23 Breggin (2003/4) http://www.breggin.com/31-49.pdf

Ref 24 Pert CB. Ph.D., (2001) http://ecommerce.drugawareness.org/Ribbon/SSRIMeds.html

Ref 25 Naveed Iqbal, MD, et al, (2007) http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1262

Ref 26 Hall LM et al (1995) http://www.ncbi.nlm.nih.gov/pubmed/7543647

Ref 27 Grace Jackson MD (2009) Drug Induced Dementia. A Perfect Crime Bloomington, IN: Author House.

Ref 28 Siegel A, Bhatt S. (2007) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435345/

Ref 29 Stefan M. Brudzynski, et al (1990) http://www.ncbi.nlm.nih.gov/pubmed/2293258

Ref 30 Graeff FG. (1994) http://www.ncbi.nlm.nih.gov/pubmed/7916235

Ref 31 Imperato A. et al, (1993) “Evidence that neuroleptics increase striatal acetylcholine release through stimulation of dopamine D1 receptors” http://jpet.aspetjournals.org/content/266/2/557.abstract

Ref 32 Donald W. Black, Nancy C. Andreasen – Introductory Textbook of Psychiatry – (2011) 5^th Edition p.544 American Psychiatric Publishing Inc.

Ref 33 Kasantikul D, Kanchanatawan B, (2006) http://www.ncbi.nlm.nih.gov/pubmed/17214072

Ref 34 Tanya C. Warwick, et al, (2008)

http://www.nature.com/nrneurol/journal/v4/n3/full/ncpneuro0728.html

Ref 35 Davies et al, (2000) http://www.national-toxic-encephalopathy-foundation.org/oppest.pdf

Ref 36 Singh S, Sharma N. Neurological syndromes following organophosphate poisoning. Neurol India 2000;48:308. http://www.neurologyindia.com/text.asp?2000/48/4/308/1510

Ref 37 Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010 Stephen Ilyas and Joanna Moncrieff (2012)

http://bjp.rcpsych.org/content/early/2012/03/10/bjp.bp.111.104257.abstract

Ref 39 Genelex http://www.healthanddna.com/healthcare-professional/dosing-recommendations.html

Ref 40 Genelex http://www.healthanddna.com/healthcare-professional/p450-2d6-genotyping.html

Ref 41 Clinical and Translational Science: Principles of Human Research by David Robertson and Gordon H. Williams Academic Press Inc; 1 edition (16 Jan 2009) Chapter 21 page 303

Ref 42 Aklillu et al, 2003 CYP1A2 allele nomenclature http://www.imm.ki.se/CYPalleles/cyp1a2.htm

Ref 43 Todesco et al (2003) http://www.ncbi.nlm.nih.gov/pubmed/12851801

Ref 44 Asian PM for 2D6 Cozza et al 2003 and Richelson 1997 in Clinical Manual of Geriatric Psychopharmacology By Sandra A. Jacobson, Ronald W. Pies, Ira R. Katz Publisher: American Psychiatric Press Inc.; 1 edition (30 Jan 2007) Page 44 & 45

Ref 45 Joan Arehart-Treichel (2005)

http://pnhw.psychiatryonline.org/content/40/10/33.1.full

Ref 46 Lucire Y, Crotty C, (2011)

http://www.dovepress.com/articles.php?article_id=7993

Ref 47 Bradford LD, Kirlin WG. (1998). http://www.ncbi.nlm.nih.gov/pubmed/11281961

Ref 48 Benny K. Abraham, C. Adithan (2001) http://medind.nic.in/ibi/t01/i3/ibit01i3p147.pdf

Ref 49 Genelex http://www.healthanddna.com/healthcare-professional/p450-2c19-genotyping.html

Ref 50 APRIL, Adverse Psychiatric Reactions Information Link http://www.april.org.uk/main/index.php?uid=269

Ref 51 Mental Health Foundation – Black and Minority Ethnic Communities

http://www.mentalhealth.org.uk/help-information/mental-health-a-z/B/BME-communities/

Ref 52 Stephen Pereira et al, (2006)

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=651260

Ref 53 Anthony Feinstein and Frank Holloway(2002)

http://isp.sagepub.com/content/48/1/38.short

Ref 54 Len Bower (2008)

http://www.kcl.ac.uk/iop/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevPICU.pdf

Ref 55 Community Care For everyone in social care “Mental Health Act detentions rise sharply for BME groups”

http://www.communitycare.co.uk/Articles/25/11/2009/113253/mental-health-act-detentions-rise-sharply-for-bme-groups.htm

Ref 56 National Mental Health Development Unit. BME Groups and Mental Health – Presentation and Evidence to the Centre for Social Justice Mental Health Review 18 October 2010. www.nmhdu.org.uk/silo/files/bme-groups-and-mental-health-.doc

Ref 57 Violence: The Short-Term Management of Disturbed/Violent Behaviour in Psychiatric In-patients and Emergency Departments Guideline, Appendix 1: Ethnicity review evidence tables. p.447 http://www.rcn.org.uk/__data/assets/pdf_file/0003/109812/003017_appendices.pdf

Psichiatria

Pharmageddon

‘

Q&A: Psychiatrist Dr. David Healy Defines ‘Pharmageddon’

Dr. David Healy has spent decades delving into the dark corners of the pharmaceutical industry, where, for instance, drug companies have tried to hide the worrisome connection between antidepressant drugs and suicide. In the psychiatrist’s best-known previous books, The Antidepressant Era and Let Them Eat Prozac, Healy explored the often vexing history of the mental health field and its troubled relationship with Big Pharma. In his latest book, Pharmageddon,he presents an even bleaker picture of the way industry has co-opted medicine in general — not just mental health. Healthland spoke with Healy about his findings.

What do you mean by ‘pharmageddon’?

At the moment, treatment-induced death is the fourth leading cause of death [overall], and within the mental health field, it’s probably the leading cause of death.

It’s a little bit like climate change. It may feel great to have a car, the convenience you get is a thing we appreciate each time we hop in the car and drive down to the market. But the use of cars is contributing to the bigger picture of climate change. In the same way, quite a few medications we take produce good outcomes. But we’ve [had a] climate change in medicine, which runs the risk of completely destroying medicine as we’ve known it.

And the key tool in all of this is how companies use the scientific evidence. They construct trials to get the outcomes they want; they only publish positive trials. The study often shows the opposite of what the data actually shows.

In the book, you look at how drug companies sell us on reducing risks — like say, high cholesterol — that may not actually do much to keep us healthy because high cholesterol itself is just a marker for cardiovascular disease risk, not an illness itself.

If you [look at] statins to lower cholesterol or drugs for osteoporosis, there’s no obvious benefit like there is from wearing a parachute when you jump out of a plane. You often just don’t feel good and you may feel a good deal worse. There isn’t even a proven benefit at the end. What you’ve got is proof in the sense of demonstrating that over a six-week period, you can show a marginal change that we have agreed to call a change for the ‘better.’ [The point is that the measure doesn’t necessarily mean your health will improve, but rather is just a marker linked with a reduction in risk.]

Trials get used as tool to persuade doctors to persuade you to have treatment. [And making drugs] available on prescription only is a means to persuade you to take things that if you were more naturally cautious, you’d be less inclined to take.

But don’t we need clinical trials to eliminate quack remedies and look systematically at the best treatments?

There’s two [situations] where trials are useful. There’s an area were you don’t need trials at all, where the treatment really works, such as antibiotics for serious infections. And they’re also really useful when they show that something doesn’t work.

What we’ve got is what’s in between, where in actual fact [some] people would say, for example, if you take all the trials of antidepressants, they actually show that the drugs didn’t work.

MORE: New Research on the Antidepressant-vs.-Placebo Debate

Yet many people say they experience profound changes after taking the antidepressant drugs like Prozac — some positive and some negative.

That’s not saying that they don’t work — a bunch of people swear that they’re working. The problem is that if we had all the data available [including the data that the drug companies hid], we ought to have said, ‘We’re not impressed by these drugs. We need to go to back to the drawing board and find the people who really benefit.’ There’s a bunch of people on [antidepressants] who clearly do well. But the companies have made whatever billions of dollars [selling them to a lot of people who don’t].

What do you think about the link between antidepressants and suicide? You’ve found some pretty damning evidence that healthy people may become suicidal or aggressive when they take these drugs.

There’s a group of people for whom antidepressants in general work awfully well, but there’s also a group for whom they don’t work well and they can become either violent or suicidal. The problem again comes back to the role of the doctor. If doctors can’t see that drugs may be good and may be bad, that they can be useful and problematic — if they aren’t experts and can’t handle a bit of complexity — they’re going to go out of business. The problem with doctors and antidepressants making people commit suicide is when it first came out about some children being suicidal, the American Psychiatric Association said that it believed that antidepressants save lives.

I’ve been trying to say to doctors, this is a professional suicide note. What they should say is, Psychiatry can save lives. We know that these pills are good for some and not others and it takes expertise to manage this. If don’t take that [perspective], well, there are cheaper people like nurses, and if pills have no risk and work well, there are cheaper people going to be prescribing.

Why do you emphasize the issue of prescribing privileges so much?

When you come to me for treatment, in sense you’re my hostage. If I ask you if something is wrong [in terms of side effects, you say], ‘No, things are fine.’ You may be having strange thoughts, you may be getting aches and pains you didn’t have before, but the problem is that you either want to keep me happy and so you don’t mention it, [or you say nothing] because I’ve told you that you have to be on these pills because otherwise you will have a heart attack or stroke. You may not even know that the problem is caused by the pill. As a doctor, I’m not trained to pick up that these things may be going on.

The other I’m thing not trained in is that when things are available by prescription only, it’s me, the doctor that ‘consumes’ the pill. I’m the consumer in the sense that companies market these drugs [to me] — in the case of pharma, they’re spending more on marketing than Apple spends or Microsoft or GM. [While those companies] market to all of us, the amount of dollars per head is small. But pharma markets to doctors. Direct-to-consumer ads are only a small part of budget and they’re designed not [just] to get you to believe in the pill, but get you to bring pressure to bear on doctors.

Wouldn’t a big part of the problem be solved simply by requiring drug companies to release all their data?

There should be a law requiring them to reveal all the data. I think that’s a key thing: there should be access to all of the data from the clinical trials. We take risks with new pills on an understanding that the data is going to be made available to experts to sift through and let us all know what the true profiles of these pills are.

If people entering into trials were asked to sign form saying, ‘Do you agree to have pharmaceutical companies sequester the data from this trial?’ they wouldn’t have signed it. Most assumed that because it appears to be science, that the scientific community will get to scrutinize the trials.

You’re personally working on a project to help bring more of the risks to light.

What we’re trying to do with our colleagues is to open up patient adverse event reporting. It’s called rxrisk.org, which will be a website where both people on pills and their doctors can go to report adverse events that may be happening. The idea is to give you a tool so that if things are going wrong, you can get an expert report from us about what is known about the links between the problem and the pills you’re on and by asking a few questions, try to pinpoint whether the pill actually causing the problem. That will give you a report to take to your doctor to make it easier to overcome the kind of hostage problem most people have when they go to the doctor and want to keep him or her happy. The idea is ultimately to create teamwork between doctors and patients and let them know in real time how many other people have reported this problem also.

We’re trying to put patients and doctors in the kind of position where, if they know that thousands of others have had this problem and then the pharmaceutical company says there’s no linkage, people won’t believe it and will say, This isn’t right. It’s in beta at moment.

So what else can be done?

There are ways to play with the system to get the outcomes we want. At the moment, we have a system that works well for the health of pharmaceutical companies but not so well for our health. I’m just trying to raise these issues. How best we solve them is a different matter, but we can’t begin to try to solve them if we don’t raise them. I’m not hugely hopeful but not entirely pessimistic either.

See more of Healthland’s ‘Mind Reading’ series.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

Senza categoria

Gli antidepressivi come i placebo

Depression

New Research on the Antidepressant-vs.-Placebo Debate

By Maia SzalavitzJan. 18, 2012Add a Comment

(Updated) In the 1990s, everyone was “Listening to Prozac,” after best-selling author Peter Kramer described sparkling personality transformations in patients who took the titular antidepressant drug. Then came the backlash: by the early 2000s, studies showed that Prozac and other selective serotonin reuptake inhibitors, or SSRIs, weren’t exactly miracle pills but were instead associated with suicide, especially in kids and teens. Another whiplash-inducing turn came in 2008, when a review of the research found that the drugs were actually no more effective than sugar pills, except in cases of the most severe depression.

Last month, research published in the Archives of General Psychiatry sought to help explain the paradoxical findings on SSRIs and other new generation antidepressant drugs, the increasingly popular medications that are now used by more than 1 in 10 Americans over 12. Using a new statistical approach, researchers led by Dr. John Krystal at Yale University School of Medicine reanalyzed data from seven clinical trials involving 2,515 patients, whose results were used to win FDA approval for the SNRI (a drug that affects both serotonin and norepinephrine) duloxetine (Cymbalta).

Known as growth-mixture modeling, the statistical technique allowed the authors to track how individual patients improved or worsened over time in response to medication or a placebo. The researchers found that roughly three-quarters of patients did better on medication than on a placebo. “That’s much more than half and half. That’s quite favorable,” says Krystal.

However, Krystal adds, just under a quarter of patients did not respond well to drug treatment and in fact did worse on antidepressants than did patients who were given a placebo.

MORE: Report: 1 in 5 American Adults Takes Mental Health Drugs

The benefit of growth-mixture modeling is that it reveals treatment trajectories of patients rather than looking at outcomes on average. When some patients get better while others get worse, the true impact of the drug may be “canceled out” in the data if they are considered only in the aggregate, obscuring both the drug’s harms and its benefits. That may help explain why some research finds that antidepressants work no better than a placebo.

“This has enormous implications for understanding the limits of the effectiveness of our current medications,” says Krystal. “These data really caution against the demonization of antidepressants as merely placebo, but they do raise a concern that some people are better off on placebo than on the antidepressant that they’re getting.”

Irving Kirsch, professor of psychology at the University of Hull in England and author of a 2008 meta-analysis in PLoS Medicine that found little benefit of antidepressants for most patients, is less sanguine about the new study. He characterizes the results as “indeed important” but says they suggest that “while many people may benefit from antidepressant treatment (although most of them to a degree that is not clinically significant), about 1 in 4 are made worse.”

“What makes this particularly problematic is the fact that we don’t know who these people are,” Kirsch says. “Although placebo may not be a viable treatment option, there are other treatments that on average work as well as antidepressants, [such as] physical exercise and cognitive behavioral psychotherapy. As far as we know, these alternatives don’t make people worse.

“This suggests to me that antidepressants should be kept as a last resort, and if a person does not respond to the treatment within a few weeks, it should be discontinued,” says Kirsch.

Krystal agrees that if one-quarter of patients with depression are made worse by antidepressant treatment, “we need to find ways to identify who those people are and find other ways to reach that group of people.”

MORE: Study Shows Antidepressants Affect Brain Differently than Placebo

Krystal’s study also found that people who improved on a placebo did so as quickly as those who improved with medication. This is important because it suggests that using a “washout period,” a technique used in some clinical trials to weed out placebo responders by eliminating participants who respond quickly, may not work with antidepressant studies.

“It counteracts the expectations that the field has that placebo response is fast and drug response is slow. Simply having a brief placebo-exposure period is not likely to eliminate the impact of placebo on outcome,” Krystal says.

That further complicates efforts to figure out the true effects and mechanism of antidepressant drugs. “We’re going to have to study people who are worse off on drug than placebo, and [not knowing who they are] will make it harder to determine whether there’s a statistically significant effect of the drug.” And given that it may be difficult to eliminate placebo responders simply through clever study design, questions about how antidepressants work, and in whom, may not be resolved until genetic or other tests can be devised to predict individual responses.

“This going to remain a challenge for study for some time,” concludes Krystal, whose latest study was funded by the government but who has received industry funding for other research.

MORE: Study: Stress-Depression Connection Sheds Light on Antidepressant Effects

A separate study published in the American Journal of Psychiatry (AJP) in December highlights other potential complications. The authors of that paper report that since 1980, the percentage of depressed patients responding to a placebo in clinical trials has risen by 7% per decade, reaching 50% in some studies.

Why? In the early years, participants for antidepressant trials were recruited from psychiatric hospitals, which meant that only the most severe cases were included. Today, however, participants are often recruited through advertisements and are paid to be in the trials. That introduces two problems that skew study populations: the most seriously depressed people often lack the capacity even to make a phone call in response to an ad and are thus overlooked, while other people may be persuaded to exaggerate symptoms of depression in order to participate in the trials and get the money. The authors of the AJP study report cases of “professional guinea pigs” who faked symptoms or enrolled in several trials at once.

Given the complexities of studying antidepressants — which appear to be placebos for some, poisons for others and miracle pills for yet others — it seems that data analysis in antidepressant research will likely remain a growth industry for decades to come. Until scientists can work it out, patients and psychiatrists will have to try multiple methods to treat depression until they hit on something that helps, keeping in mind that antidepressant drugs may backfire for some patients.

MORE: Why American Presidents (and Some Oscar Winners) Live Longer

Correction [Jan. 23, 2012]: The original version of this story mischaracterized Cymbalta as a selective serotonin reuptake inhibitor, or SSRI. The antidepressant drug is an SNRI, which affects both norepinephrine and serotonin.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.

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Nel caso di Breivik l’errore è eclatante ma è rivelatore di un universo sommerso di errori, disseminati a macchia d’olio su scala planetaria ,che rischiano di trasformare gli Usa (ma non solo ), la patria del DSMIV e V, in un manicomio a cielo aperto.

Ed In Italia?

Breivik’s cell and the absurdity of the penalty

LA CELLA DI BREIVIK

Breivik has not gone on a hunger strike

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Right Truth

Counterterrorism, politics, religion, …

DECEMBER 21, 2012

Adam Lanza Taking Antipsychotics

The Antipsychotic Prescribed To Adam Lanza Has A Troubled History All Its Own:

Fanapt (iloperidone)

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Neuroleptic Drugs and Violence

Introduction

Violence is reported with command hallucinations: 48% experienced harmful or dangerous actions and this increased to 63% in medium secure units and was significantly higher, 83%, in the forensic population.2

· Violence

· Neuroleptic Withdrawal Adverse Effects on Behaviour

· Neurotransmitter Functioning and Behaviour

· Increased Prescribing of Neuroleptics as a Risk for Increased Violence

Violence

Adverse Effects on Behaviour of Neuroleptics

Adverse Reactions Related to Violence

Clozaril

Neuroleptic Withdrawal Adverse Effects on Behaviour

Neurotransmitter Functioning and Behaviour

Violence

Neuroleptics and Acetylcholine Disruption

Chart Depicting the Symptom Similarities of NMS and OP

Aggression, agitation and violence

Conclusion: Organophosphates, Neuroleptics and Violence

Increased Prescribing of Neuroleptics

Increased Prescribing as a Risk for Increased Violence

Synopsis

Violence must be considered not simply as an indication of how deeply schizophrenia /bipolar illness can worsen, but as an adverse effect of neuroleptic treatment.

References:

Ref 2 Birchwood et al. (2011)

Ref 41 Clinical and Translational Science: Principles of Human Research by David Robertson and Gordon H. Williams Academic Press Inc; 1 edition (16 Jan 2009) Chapter 21 page 303

Ref 42 Aklillu et al, 2003 CYP1A2 allele nomenclature http://www.imm.ki.se/CYPalleles/cyp1a2.htm

Ref 44 Asian PM for 2D6 Cozza et al 2003 and Richelson 1997 in Clinical Manual of Geriatric Psychopharmacology By Sandra A. Jacobson, Ronald W. Pies, Ira R. Katz Publisher: American Psychiatric Press Inc.; 1 edition (30 Jan 2007) Page 44 & 45

Ref 46 Lucire Y, Crotty C, (2011)

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Violence is reported with command hallucinations: 48% experienced harmful or dangerous actions and this increased to 63% in medium secure units and was significantly higher, 83%, in the forensic population.²