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October 21, 2018 by Bernalyn Ruiz | MadInAmerica.com

Gradual Tapering is Most Successful for Withdrawal from Antipsychotics

Mixed-methods study explores the experiences of antipsychotic discontinuation among service users

(MadInAmerica.com) – A mixed-methods study published in the journal Psychiatry Research surveyed individuals who had attempted, at least once, to discontinue taking antipsychotic medications. Fifty-five percent of participants reported successfully stopping, and 50% reported no current use. In the findings, a gradual approach to withdrawal was positively associated with successful discontinuation and was negatively associated with relapse, suggesting that gradual withdrawal (more than one month) is a more effective method of discontinuation.

The authors write that, “When considered in conjunction with the longitudinal research and studies exploring psychiatric medication withdrawal in general . . . discontinuation is a legitimate choice that requires and justifies appropriate support.”

Persons prescribed antipsychotics often make adjustments to their medications independent of their prescriber or attempt to discontinue the medication on their own. As the authors point out, 60-80% of individuals with schizophrenia spectrum diagnoses report discontinuation.

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October 21, 2018 by Abigail M. Freeman, B.Sc., M.Sc. et al | Psychiatric Services

Open Dialogue: A Review of the Evidence

(Psychiatric Services)

 

Abstract

Objective:
Emerging evidence for Open Dialogue (OD) has generated considerable interest. Evidence comes from a range of methodologies (case study, qualitative, and naturalistic designs), which have not been synthesized as a whole. The objective of this review was to synthesize this literature.

Methods:
A systematic search of the databases PubMed, CINAHL, Scopus, Web of Science and PsycINFO included studies published until January 2018. A total of 1,777 articles were screened. By use of a textual narrative synthesis, studies were scrutinized for relevance and quality.

Results:
Twenty-three studies were included in the review; they included mixed-methods, qualitative, and quantitative designs and case studies. Overall, quantitative studies lacked methodological rigor and presented a high risk of bias, which precludes any conclusions about the efficacy of OD among individuals with psychosis. Qualitative studies also presented a high risk of bias and were of poor quality.

Conclusions:
Variation in models of OD, heterogeneity of outcome measures, and lack of consistency in implementation strategies mean that although initial findings have been interpreted as promising, no strong conclusions can be drawn about efficacy. Currently, the evidence in support of OD is of low quality, and randomized controlled trials are required to draw further conclusions. It is vital that an extensive evaluation of its efficacy takes place because OD has already been adopted by many acute and community mental health services.

 

Source: PS.Psychiatryonline.org/doi/10.1176/appi.ps.201800236

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October 19, 2018 by Liam Davenport | Medscape

SSRIs a ‘Double-Edged Sword’ in Major Depression?

BARCELONA, Spain – Use of selective serotonin reuptake inhibitors (SSRIs) appears to amplify the living environment of patients with major depressive disorder (MDD) in a dose-dependent manner, so that those in more positive situations are more likely to achieve remission compared with their counterparts living in less favorable conditions, new research shows.

Investigators led by Igor Branchi, PhD, Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy, explored the hypothesis that SSRIs may not “affect mood per se but [may amplify] the influence of living conditions on mood.”

The clinical implications of the finding are “tricky,” Branchi told Medscape Medical News. One potential implication may be that “patients living in adverse environments should not be treated with SSRIs because they may not benefit.” However, he added, further study is needed before any firm conclusions can be drawn about the drugs’ use in particular patient groups.

The findings were presented here at the 31st European College of Neuropsychopharmacology (ECNP) Congress.

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October 17, 2018 by Jessica Pratt, EXCELLENCE Editor

C.O.P.E. Policy Pressure Group Strives To Better Safeguard Young Children From Prescribed Psychiatric Drugs

(MadInAmerica.com) – From The British Psychological Society: “C.O.P.E. [Campaign against the Over-prescription of Psychiatric drugs in Education] is a group of child mental health professionals…[whose] primary aim is to change public policy in key areas of child and adolescent mental health…an attempt to initiate this change was made as part of the consultation process for the new NICE [National Institute for Health and Care Excellence] Guidelines.

The BPS requested that NICE should consider recommending a ban on medicating children with psycho-stimulants who are under the age of five years old…Our C.O.P.E. mission statement clearly articulates our collective beliefs well and includes this area of policy:

We share the view that a caring and morally mindful society must better safeguard children by allowing them to develop their unique personalities and behaviours without a first response to prescribe psychiatric drugs for their behavioural difficulties.

We especially believe that children under the age of five should not be prescribed psychiatric drugs if their behaviour is the only concern.

Please help us to better safeguard children, which is our shared primary duty, and challenge the inappropriate use of psychiatric drugs in the young by signing the petition and supporting our objectives through professional discussions in mental health teams and childrens’ services.”

Source: Madinamerica.com/2018/10/c-o-p-e-strives-better-safeguard-children/

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October 17, 2018 by Sera Davidow | MadInAmerica.com

55 Steps to Informed Consent

(MadInAmerica.com) – Warning: I made the decision to include ‘spoilers’ in this piece. As this is a true story, the information I reveal is already circulating. Additionally, it is pivotal to why I feel people should see this film — and, most importantly, ensure other people beyond this community get exposed to this film. Maybe even involuntarily.

“Everybody’s here to ‘help’ me. That’s why I need help.”

– Eleanor Riese

“I always thought it was my primary job to care for the patient, not manage them for my own convenience.”  

– Collette Hughes

 

 

55 Steps is a new film (though long in the making) written by Mark Rosin, directed by Bille August, and starring Helena Bonham Carter and Hilary Swank. In some ways, it’s one of those unlikely ‘buddy’ films. However, this time, rather than featuring some iteration of two men bonding, it centers around two women: a lawyer with a tendency to work long hours, and Eleanor Riese, whose stacks of journals documenting her journey with psychiatric drugs indicate that she has spent far too much time incarcerated in hospitals.

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October 17, 2018 by Batya Swift Yasgur, MA, LSW | Medscape

Psychotropic Polypharmacy Common in Alzheimer’s Despite Risks

(Medscape) – Close to half of people with Alzheimer’s disease (AD) take a psychotropic drug, and one fifth use two or more psychotropic drugs concomitantly, new research shows.

Investigators analyzed data from a nationwide Finnish study that included more than 70,500 individuals with AD and found a threefold increase in the use of two or more psychotropic drugs, including antipsychotics, antidepressants, and benzodiazepines and related drugs (BZDR), from 5 years before a diagnosis of AD to 4 years after.

Patients aged 75 years and younger, women, and those with a history of psychiatric disease were more likely to receive psychotropic polypharmacy (PPP).

The use of acetylcholinesterase inhibitors (AChEIs) was associated with a decreased risk for PPP, whereas use of memantine (multiple brands) was associated with an increased risk.

“Use of psychotropic drugs is very common, as up to half of people with AD use a psychotropic drug, and 1 in 5 use two or more concomitantly,” lead author Sirpa Hartikainen, MD, PhD, professor of geriatric pharmacotherapy, School of Pharmacy, University of Eastern Finland, told Medscape Medical News.

“Clinicians should avoid psychotropic pharmacology and assess on a regular basis the need for any psychotropic drug use in persons with cognitive disorder,” she said.

The study was published online August 25 in European Neuropsychopharmacology.

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October 17, 2018 by Pauline Anderson | Medscape

Schizophrenia in Youth Not a Neurodegenerative Illness

(Medscape) – Young patients with recent-onset schizophrenia do not show signs of cognitive deterioration or disruption of ongoing brain development in the first years following illness onset, new research shows.

Results of a large longitudinal study show that young patients with schizophrenia experience cognitive impairment prior to the onset of psychotic symptoms, but the trajectory of their neurobehavioral development and performance is comparable to that of healthy control persons.

“The study results suggest that whatever effect cognition has in schizophrenia seems to happen before people develop clinical symptoms, the psychotic symptoms,” study investigator Cameron S. Carter, MD, professor of psychiatry and psychology, and director of the Schizophrenia Research and Education Program, Department of Psychiatry and Behavioural Sciences, University of California, Davis, told Medscape Medical News.

“So cognitive dysfunction is already there when people come in for treatment,” he said.

The findings are in line with the neurodevelopmental model of schizophrenia. This model hypothesizes that prenatal central nervous system insultsand/or genetic alterations during early brain developmentinteract with environmental risk factors and lead to the onset of psychosis in late adolescence or early adulthood.

“The study confirms our sense that schizophrenia is not a neurodegenerative disorder; the brain does not necessarily deteriorate after people become ill and develop these symptoms,” said Carter.

“In fact, these young people have the capacity to continue to improve and develop to the same degree as typical individuals,” he said.

The study was published online October 3 in JAMA Psychiatry.

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October 17, 2018 by Jonathan Leo Ph.D. | Psychology Today

Are We Labeling Normal Development as Pathology?

Youngest children in the classroom are more likely to be diagnosed with ADHD.

(Psychology Today) – A just published study by a team of researchers (which I am part of) has shown that it is the youngest children in the classroom who are most likely to be diagnosed with ADHD. The systematic review was published in the Journal of Child Psychology and Psychiatry. Seventeen studies covering more than 14 million children from various countries were examined. Lead author Martin Whitley commented in the Daily Mail that “It appears that across the globe some teachers are mistaking the immaturity of the youngest children in their class for ADHD.” The study contributes to the central debate about ADHD and the question of medicalization: Do children diagnosed with ADHD have a brain disease?

Medicating the younger children in the classroom suggests that the medical community has mislabeled normal brain development as a pathology. If the ADHD children are simply the youngest children in the classroom, this would explain why researchers have not been able to develop an object test such as a brain scan, blood test, or genetic test to diagnose ADHD.

In spite of the fact that there are no biological markers that can be used to diagnose ADHD, official outlets can give the impression that this is the case. A recent brochure on ADHD from The National Institutes of Mental Health(NIHM) states that: “Brain-imaging studies have revealed that in youth with ADHD, the brain matures in a normal pattern but is delayed by about three years.” It continues, “More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall.” It would be hard to fault the general public for concluding that brain scans can be used to identify ADHD. Not mentioned by NIMH is that the studies they refer to detected miniscule differences in a small group of children, and that the scans cannot be used in a doctor’s office to determine if a child should be diagnosed with ADHD.

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October 17, 2018 by Madison K. Kilbride, PhD; Steven Joffe, MD, MPH | JAMA

The New Age of Patient Autonomy

Implications for the Patient-Physician Relationship

(JAMA) – The rejection of medical paternalism in favor of respect for patient autonomy transformed the patient-physician relationship. Historically, medicine and society subscribed to the ethical norm that the physician’s main duty was to promote the patient’s welfare, even at the expense of the latter’s autonomy. A central assumption of the paternalistic framework was that physicians, because of their medical expertise, knew best what was in the best interest of patients. Accordingly, physicians decided which interventions would promote patients’ welfare; patients, for their part, were expected to comply.

The decades since the 1950s have seen an increasing emphasis on patients’ rights to accept or decline recommended treatment. The rejection of medical paternalism did not, however, overturn physicians’ control in their relationships with patients. In theory, physicians could no longer make unilateral decisions about their patients’ care, but in practice, they retained gatekeeping authority by virtue of their monopoly over medical information and most medical resources. This characterization of the patient-physician relationship, with patients in control of their medical decisions but dependent on their physicians for access to information and most medical products and services, is no longer accurate. Medicine has entered a new age of patient autonomy. Today’s patients, informed by the internet and social media, are increasingly less dependent on their physicians for access to medical information and resources. This revolutionary change requires a fundamentally different understanding of the patient-physician relationship.

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October 17, 2018 by RxISK.org

Can Antidepressants Make You Less Attractive?

(RxISK.org) – In recent years, there has been increasing concern about the problem of antidepressants finding their way into the environment. These drugs aren’t fully absorbed by the body and are present in human waste. Small concentrations are then flowing into rivers via wastewater treatment facilities where wildlife can be affected.

In August 2018, several media outlets reported that antidepressants were having a negative effect on the courting behavior of starlings (birds), specifically that males were singing less to females and showed signs of decreased interest.

A cursory glance of the headlines suggested that this might be the issue of antidepressants causing reduced sexual interest and disruption of normal social behaviors. Almost everyone who takes an SSRI or SNRI will be affected sexually to some degree, and these drugs can also cause emotional blunting, potentially affecting feelings of love towards a partner. But in this case, there was an unexpected twist to the story.

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The contents of this Headlines page are provided for informational purposes. Any material, conclusions, or opinions presented in the linked articles are not necessarily endorsed by the Foundation for Excellence in Mental Health Care.