Psychopharmacological Approach

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

My 6 year anniversary off psych drugs

How I made it through the darkest times, February 9, 2016 by Monica Cassani See you tube

 

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

On the 2012 IEPA conference Lex Wunderink presented a talk on a randomized controlled trial that indicates that anti-psychotic medication must be used with precaution, in as low a dose as possible and some people can do without. A RCT found that after 7 years, clients who received medications in as low and intermittent dose as possible functioned better than clients who received standard medication. see article

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

How to minimize doses of neuroleptics?

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

General information on medication

Drugs.comAn excellent site to obtain general information about all existing medications: side effects, interactions, a pill-identifier and so forth, for clients and professionals

Also information on drugs from the institute of psychiatry in London, and this webpage

 

Randomized Controlled Trials

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

What is a randomized controlled Trial? From Wikipedia 

The critics from Peter Gøtzsche v.i. was that the side effects of medication make that patients know the difference between placebo condition and treatment condition. Also researchers did stop medication rapid, so the psychosis which recurred is probable withdrawal. 

The function of D2 receptors in the brain

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

This video describes some of the cognitive functions of dopamine in your brain 

The working of neurotransmitters. 

The role of the basal ganglia in psychosis, advanced information, from Paul Morrison for Robin Murray, researcher on cannabis and psychosis 

Side effects of antipsychotic medication

Movement disorders like Akathisia and dystonia

Acute Dystonic Reaction A patient treated with risperidone presents to the emergency department with an acute dystonic reaction. The acute management of the extrapyramidal effect of his medication with benadryl is demonstrated in this video

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

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

Diabetes, Psychiatric Disorders, and the Metabolic Effects

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

The critics on medication

Robert Whitaker is one of the main critics of medication. His view is that medication causes changes in the brain and when patients discontinue the drugs abruptly, they get a psychosis because of a rebound effect.

52nd Maudsley Debate: More Harm Than Good? Debate on pro and con's of long use of medication. see film

Chair: Professor Til Wykes, Professor of Clinical Psychology & Rehabilitation and Vice-Dean, Psychology & Systems Sciences, IoPPN

For:  

Professor Sami Timimi, Consultant Child & Adolescent Psychiatrist; Director of Postgraduate Education, NHS Lincolnshire; Visiting Professor of Child & Adolescent Psychiatry, University of Lincoln

Professor Peter Gøtzsche, Director, The Nordic Cochrane Centre, Denmark

Against:

Professor Allan Young, Professor of Mood Disorders, IoPPN

Mr John Crace, Journalist, The Guardian

Midstream psychiatry on medication:

Professor Bernard Lerer on 'Pharmacogenetics of Antipsychotic Drug’  A more midstream lecture on antipsychotics, most psychiatrists will agree with the content. Most psychiatrists admit that antipsychotic medication can diminish acute psychotic symptoms, but not chronic symptoms and do not diminish problems with cognitive functioning

Alternatives for medication

The opinion of brain scientists on psychotherapy, good experiences can change the brain

Scientist used to think that the brain was formed during early ages, but this proved to be not true. That’s why experiences and not only drugs can change the brain! see film

A famous psychopharmaceutic researcher S. Stahl published an article with the same scope 

A safe environment

A friendly holding environment, like Soteria house, has been proven to be an alternative for psychotic persons to manage their intensive and overwhelming experiences. Soteria house was researched by Mosher and had a better outcome than a day clinic 

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

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

By the way and Loren Mosher and the clinicians of open dialogue sometimes used low dose medication if needed. 

Stopping medication

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

Coming Off Psychiatric Drugs: A Harm Reduction Approach to Medication Withdrawal | Will Hall 

A bit older book on coming of drugs is from Peter Lehman. Lehmann, Peter (ed.). (2002). Coming off Psychiatric Drugs    
 

Recommendations from the editer (community psychiatrist) in case you want to stop medication

  • Make first a good crisis plan with all people that are important in case you become psychotic, inform yourself also how other people experience you when you have a psychosis. Sometimes people make plans what to do when psychotic but do not follow their plans when they have a psychosis. Think about the risks you want to take (may be different than the risks your psychiatrist want to take)
  • Show the harm reduction guide to your doctor (read it first)
  • Taper down very slow!!! Otherwise there will be a very big chance that you get a withdrawal psychosis (In the studies on medication,  medication was stopped abruptly, a very serious flaw and a shame)
  • Taper down the last bit very, very slow. Why? I will show you:

saturatiecurve

The relationship between the dosage of medication and the amount of this stuff on the recepterplate of your braincells has the shape of a saturation curve. This means that tapering of a high dose (b) to a less high (a) dose has not so much influence, but the last bit of medication tapered of (d to c) has the result that receptor plates are empty very fast!

Some people can do without medication without becoming psychotic again or they can handle psychotic symptoms with support of family and friends,  some people may need to use a small dose.

 

Remember the motto of rehabilitation movement

Change what you can change

Accept what you can't chanage 

And may God give you the wisdom to know the difference!

 

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