>They generally recommend maintenance treatment for recurrent depression, bipolar I disorder, and schizophrenia, ignoring controversies in these areas. They assume, for example, that most people are correctly diagnosed when the reality is that there is widespread diagnostic chaos and medication decisions about maintenance are made under considerable uncertainty.
This is one of the challenges I deal with regularly in my setting (corrections). We get a database showing the patient has been hospitalized many times, with diagnoses of Schizophrenia / Schizoaffective / Bipolar Disorder all over. Many psychiatrists automatically assume those to be valid and prescribe an antipsychotic, with the understandable goal of not missing or risking exacerbation of psychosis, Mania etc, and medications are continued indefinitely. No symptoms arise, and the psychiatrist and the system are happy. But the patient suffers, often silently.
Over the past couple years I have been more aggressive about deprescribing, when I think there is a reasonable argument that the chart diagnoses are invalid and better explained by substances / trauma / personality / billing needs, etc. A small number of patients have had authentic symptoms or disability emerge (and thankfully, in my setting those issues are fairly rapidly attended to), but the vast majority either experienced no change, or improve, and to me, that has been incredibly satisfying.
Wonderful post and I applaud you "taking back the narrative" of thoughtful medication management away from what are often anti-psychiatry shills.
My only quibble is that you seem to present RTCs as the path to resolving all issues with the result that deprescribing can become boring.
I used to tell my very well-informed internist that my middle name was not Median. He proceeded with a great deal of research-based certainty about the correct treatment of type 2 diabetes. Finally, he came up with a new research finding. "Research now reveals that it's OK for a person over 60 to have a hemoglobin A1C level of eight." I silently shouted, “Alleluia.!”
My comment is not directed towered Awais, but those associated with ASCP.
Why is there seldom discussion in descriptive psychiatry about the effects of sleep and lack thereof? Why is it implicitly assumed that those labeled with chronic psychosis-related disorders are getting consistent, oxygen-rich, deep sleep? Despite that the vast majority are also chronic smokers?
We already know chronic sleep deprivation (lack of oxygen) directly causes hallucinations, delusions, psychosis, and a breakdown in somatosensory coherence in that order: https://doi.org/10.3389/fpsyt.2018.00303
Is it really a coincidence that these are the criteria for the psychoses / schizophrenia spectrum?
Indeed, it might explain why people refuse to take antipsychotics long term: they directly starve the body and brain of oxygen. So when the ASPC says "We must weigh the risks and benefits", the "risks" being that someone violates society's cherished "social norms" during a temporary psychotic episode, or the so-called "benefit" of these drugs', which apparently involves dying from a disease associated with hypoxia, it should not be difficult to understand the sentiments from critical psychiatry.
It is outrageous that the general media covering psychopharmacology is calling "sleep, diet, and exercise" - activities that involve oxygen uptake - a "conspiracy theory" whenever our current health secretary prescribes them to society over pharmacology.
>They generally recommend maintenance treatment for recurrent depression, bipolar I disorder, and schizophrenia, ignoring controversies in these areas. They assume, for example, that most people are correctly diagnosed when the reality is that there is widespread diagnostic chaos and medication decisions about maintenance are made under considerable uncertainty.
This is one of the challenges I deal with regularly in my setting (corrections). We get a database showing the patient has been hospitalized many times, with diagnoses of Schizophrenia / Schizoaffective / Bipolar Disorder all over. Many psychiatrists automatically assume those to be valid and prescribe an antipsychotic, with the understandable goal of not missing or risking exacerbation of psychosis, Mania etc, and medications are continued indefinitely. No symptoms arise, and the psychiatrist and the system are happy. But the patient suffers, often silently.
Over the past couple years I have been more aggressive about deprescribing, when I think there is a reasonable argument that the chart diagnoses are invalid and better explained by substances / trauma / personality / billing needs, etc. A small number of patients have had authentic symptoms or disability emerge (and thankfully, in my setting those issues are fairly rapidly attended to), but the vast majority either experienced no change, or improve, and to me, that has been incredibly satisfying.
Wonderful post and I applaud you "taking back the narrative" of thoughtful medication management away from what are often anti-psychiatry shills.
My only quibble is that you seem to present RTCs as the path to resolving all issues with the result that deprescribing can become boring.
I used to tell my very well-informed internist that my middle name was not Median. He proceeded with a great deal of research-based certainty about the correct treatment of type 2 diabetes. Finally, he came up with a new research finding. "Research now reveals that it's OK for a person over 60 to have a hemoglobin A1C level of eight." I silently shouted, “Alleluia.!”
My comment is not directed towered Awais, but those associated with ASCP.
Why is there seldom discussion in descriptive psychiatry about the effects of sleep and lack thereof? Why is it implicitly assumed that those labeled with chronic psychosis-related disorders are getting consistent, oxygen-rich, deep sleep? Despite that the vast majority are also chronic smokers?
We already know chronic sleep deprivation (lack of oxygen) directly causes hallucinations, delusions, psychosis, and a breakdown in somatosensory coherence in that order: https://doi.org/10.3389/fpsyt.2018.00303
Is it really a coincidence that these are the criteria for the psychoses / schizophrenia spectrum?
We also know that consistent administration of antipsychotics directly causes global decreases in oxygen uptake: https://doi.org/10.1016/j.euroneuro.2018.01.004
Indeed, it might explain why people refuse to take antipsychotics long term: they directly starve the body and brain of oxygen. So when the ASPC says "We must weigh the risks and benefits", the "risks" being that someone violates society's cherished "social norms" during a temporary psychotic episode, or the so-called "benefit" of these drugs', which apparently involves dying from a disease associated with hypoxia, it should not be difficult to understand the sentiments from critical psychiatry.
It is outrageous that the general media covering psychopharmacology is calling "sleep, diet, and exercise" - activities that involve oxygen uptake - a "conspiracy theory" whenever our current health secretary prescribes them to society over pharmacology.