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February 12, 2020 by John Read & Ann Sacia | Schizophrenia Bulletin

Using Open Questions to Understand 650 People’s Experiences With Antipsychotic Drugs


Studies of antipsychotic medication, which are increasingly prescribed for a broad range of problems and circumstances, rarely ask the people who take them to describe their experiences with the drugs. In this study, 650 people, from 29 countries, responded, in an online survey, to “Overall in my life antipsychotic medications have been _____?” and “Is there anything else you would like to say, or emphasise, about your experiences with antipsychotic drugs?” Of the total participants, 14.3% were categorized as reporting purely positive experiences, 27.9% had mixed experiences, and 57.7% reported only negative ones. Negative experiences were positively correlated with age. Thematic analysis identified 749 negative, 180 positive, and 53 mixed statements. The 2 positive themes were “symptom reduction” (14) and “sleep” (14), with the majority (153) unspecified. The 4 negative themes (besides “unspecified”—191) were: “adverse effects” (316), “interactions with prescriber” (169), “withdrawal/difficult to get off them” (62), and “ineffective” (11). The adverse effects included: weight gain, emotional numbing, cognitive dysfunction, sedation, akathisia, effects on relationships, and suicidality. “Interactions with prescriber” included lack of information about withdrawal effects, support, or discussion of alternatives. The only mixed theme was “short-term good, long-term bad” (28). Open questions can add to findings from methodologies focused on symptom reduction. Clinicians should pay more attention to the need for respectful and collaborative patient-prescriber relationships. At the point of prescription, this must include providing the full range of information about antipsychotics, including potential benefits and harms, difficulties withdrawing, and information on alternatives treatments such as psychological therapies.
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December 16, 2019 by Derek Blumke |

Prescribing an Epidemic: A Veteran’s Story

In 2011, I had the privilege of joining the Department of Veterans Affairs (VA) to launch a national program to provide outreach, screening, and treatment services for veterans with depression, post-traumatic stress, anxiety, and other mental health needs. These efforts became a passion for me because during my three years as the president of Student Veterans of America (SVA), we lost some student veterans to suicide. When I received the first notification of a suicide, I felt like a commander who’d lost an airman but didn’t have the resources to stop it from happening again.

At the time, I’d viewed the VA as the consummate experts in the area of veteran mental health and suicide prevention, and felt my job offered the best opportunity to make an impact.

A few years later found me working in New York City as a tech entrepreneur. It was here that I climbed onto the train I’d previously been working to drive: I became a patient in a veteran mental health program.

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June 19, 2019 by JT Jordan and DE McNiel | Suicide and Life-Threatening Behavior

Perceived Coercion During Admission Into Psychiatric Hospitalization Increases Risk of Suicide Attempts After Discharge

(Suicide and Life-Threatening Behavior)


OBJECTIVE: There is an elevated risk for suicide in the year following psychiatric hospitalization. The present study examined whether perceived coercion during admission into psychiatric hospitalization increases risk for postdischarge suicide attempts.

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May 16, 2019 by The BMJ News

NHS prescribed record number of antidepressants last year

Clinical Guidelines on Antidepressant Withdrawal Urgently Need Updating

16 May 2019

(The BMJ) – In February 2018 the international debate on antidepressant withdrawal was reignited.[1, 2, 3, 4] In response to a letter published in The Times by Davies et al on the benefits and harms of antidepressants,[1] the Royal College of Psychiatrists publicly stated that “[for] the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.”[2]

To support this claim, the college referred to the guidelines from the National Institute for Health and Care Excellence (NICE), which state that “[withdrawal] symptoms are usually mild and self-limiting over about 1 week.”[5]

When Davies et al issued a freedom of information request to NICE asking for the evidence for its 1 week claim, NICE was able to provide only two short review articles, neither of which support the 1 week claim while both cite numerous sources that contradict it.[6]

We think that NICE’s current position on antidepressant withdrawal (first established in 2004) not only was advanced on insufficient evidence but is now widely countered by subsequent research.

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September 5, 2018 by Arefa Cassoobhoy, MD, MPH | Medscape

More Bad News About Benzos

(Medscape) – Hello. I’m Dr Arefa Cassoobhoy, a practicing internist, Medscape advisor, and senior medical director for WebMD.

Benzodiazepines are in the news again—this time, not for the increased risk for falls and fractures that can come with their use.

A case-control study was conducted in Finland among community-dwelling adults who had been diagnosed with Alzheimer disease. Benzodiazepines and related Z drug use was associated with a modestly increased risk for Alzheimer disease. No real differences were seen for the drug subcategories. This included short-, medium-, and long-acting benzodiazepines, as well as zolpidem, zaleplon, and eszopiclone.

The analysis showed that 5.7% of dementia cases among adults using benzodiazepines were due to the drugs. Even this small increased risk could be significant because they are widely prescribed to elderly adults, often long term. The drugs are given to treat prodromal and neuropsychiatric symptoms of dementia like insomnia and anxiety.

The authors concluded that benzodiazepines and Z drugs should be avoided when possible, given their adverse-event profile. For patients who you would like to wean off benzodiazepines, deprescribing can be tough and take a long time. Guidelines are now available to help you with the process.


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July 9, 2018 by Laysha Ostrow, Patricia B. Nemec, Carina Smith | The Journal of Behavioral Health Services & Research

Self-Employment for People with Psychiatric Disabilities: Advantages and Strategies

(The Journal of Behavioral Health Services & Research) – 


Self-employment is an alternative to wage employment and an opportunity to increase labor force participation by people with psychiatric disabilities. Self-employment refers to individuals who work for themselves, either as an unincorporated sole proprietor or through ownership of a business. Advantages of self-employment for people with psychiatric disabilities, who may have disrupted educational and employment histories, include opportunities for self-care, additional earning, and career choice. Self-employment fits within a recovery paradigm because of the value placed on individual preferences, and the role of resilience and perseverance in business ownership. Self-employment creates many new US jobs, but remains only a small percentage of employment closures for people with psychiatric disabilities, despite vocational rehabilitation and Social Security disability policies that encourage it. This commentary elucidates the positive aspects of self-employment in the context of employment challenges experienced by individuals with psychiatric disabilities and provides recommendations based on larger trends in entrepreneurship.

Full Text:

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December 7, 2016 by Sandra Steingard, MD

Vermont Collaborative Network Approach Launched

vermont_b-nikkelI have had the great privilege and pleasure of working with a group of colleagues in Vermont who share my interest in bringing the humble and democratic ways of working developed in northern Finland and Norway to our state. Many of us were introduced to this work by Robert Whitaker’s description of Open Dialogue in Anatomy of an Epidemic and Daniel Mackler’s documentary Open Dialogue, and some of us worked with Tom Anderson, who came to Vermont in the 90s.

Some had traveled to Europe to attend the annual meeting of the International Network for the Treatment of Psychosis, the group of clinicians who had been working in this way for the past two decades. Others had the opportunity to train with Mary Olson, PhD at the Institute for Dialogic Practice. We have formed study groups and developed small teams who are beginning to introduce this way of working to our clinics.

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November 22, 2016 by Sandra Steingard, MD

Moving ahead in troubled times

The Foundation for Excellence in Mental Health Care was founded in 2011 with the hope of expanding what many had come to believe was a narrow and faulty understanding of psychiatric conditions.

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November 3, 2016 by IA Cristea et al | Br J Psychiatry

Sponsorship Bias in the Comparative Efficacy of Psychotherapy and Pharmacotherapy for Adult Depression: Meta-Analysis

BACKGROUND: Sponsorship bias has never been investigated for non-pharmacological treatments like psychotherapy.

AIMS: We examined industry funding and author financial conflict of interest (COI) in randomised controlled trials directly comparing psychotherapy and pharmacotherapy in depression.

METHOD: We conducted a meta-analysis with subgroup comparisons for industry v. non-industry-funded trials, and respectively for trial reports with author financial COI v. those without.

RESULTS: In total, 45 studies were included. In most analyses, pharmacotherapy consistently showed significant effectiveness over psychotherapy, g = -0.11 (95% CI -0.21 to -0.02) in industry-funded trials. Differences between industry and non-industry-funded trials were significant, a result only partly confirmed in sensitivity analyses. We identified five instances where authors of the original article had not reported financial COI.

CONCLUSIONS: Industry-funded trials for depression appear to subtly favour pharmacotherapy over psychotherapy. Disclosure of all financial ties with the pharmaceutical industry should be encouraged.

Get Full Text: Journal site


© The Royal College of Psychiatrists 2017.

PubMed: 27810891

DOI: 10.1192/bjp.bp.115.179275



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March 31, 2016 by Brian Farr, MA, LPC

Celebrating Six Months at EXCELLENCE

Brian-FarrOn March 14th, I celebrated six months in my new position as Director of Philanthropy at EXCELLENCE. Why did I choose to work at EXCELLENCE and not somewhere else? I believe in the mission. I believe that five years from now, because of this organization, the mental health care delivery system in the United States will be more compassionate and more effective than it is today.

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