Talk:Antipsychotic

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Contents

[edit] Efficacy

In Skeptic magazine vol. 13 no. 3, 2007, there is an article, "The Trouble with Psychiatry," by John Sorboro, M.D. He says the following on page 42:

Even what most psychiatrists assume would be an obvious and universal approach of drug therapy to treat the most "biologic" of psychiatric diseases, schizophrenia lacks the kind of clarity most people assume exists. Recent landmark trials over 12-18 month periods funded by the US and British government involving the treatment of schizophrenia, found that regardless of medication used, many patients stopped taking medication, the medications demostrated a relatively poor efficacy, and new expensive medications did not perform any better than the old inexpensive ones.

he cites:

Bola, J.R 2006 "Medication-Free Research in early epsisode schizophrenia: evidence of long -term harm?" schizophrenia bulletin

Lieberman J A 2005, "Effectiveness of antipsychotic drugs in patients with chronic schizophrenia" new england journal of medicine

Rosenheck, R.A 2006 "Outcomes, costs, and policy caution: A Commentary on the cost utility of the latest antipstchotic drugs in schizophrenia study" Archives of general psychiatry. Sp0 (talk) 00:46, 10 May 2008 (UTC)

[edit] Classes

Added Haloperidol which is never shown under 1st generation antipsychotics. Madglee (talk) 00:03, 15 April 2008

[edit] LY2140023

now... i'm reading the article, and i've been wondering... "Dr.Sandeep Patil's team proved that LY2140023 appeared to work as an antipsychotic when tested upon rodents." - i cant help but wonder, how do you measure how psychotic a rodent is? are psychiatric drugs really supposed to show efficacy on animals during clinical trials? are drugs given to humans at random, just because they didn't manage to kill a rodent? i know this is what the source says, and its supposed to be a reliable one, but this sounds too unrealistic to me. Fdskjs (talk) 01:50, 12 April 2008 (UTC)

[edit] Antipsychiatry opposition

Someone should mention anti-psychiatry's opposition to these drugs. --Daniel C. Boyer 17:33 Jan 13, 2003 (UTC)

I think the main objection has been to the use of forced or coercive medication rather than to any particular treatment per se. Certainly Szasz would aruge that people should have free access to antipsychotic drugs but would argue against their control or imposition against someone's will. - Vaughan 12:25, 1 Aug 2003 (UTC)
I agree that this article is conspicuous by the absence of the initial point raised above. Antipsychotics were a primary target of the original 60s/70s antipsychiatry movement, often referred to as chemical straightjackets. Avoiding them (entirely or relatively) was a key part of developments like soteria. The modern antipsychiatry or consumer/survivor movement is also associated with a lot of criticism of their potentially anti-recovery long-term use, and of the basis for the huge pharmaceutical industry promotion of atypicals now that the typicals are out of patent. I'm sure it could be covered in the context of good balanced sections on effectiveness claims and adverse effects, they're a bit random-seeming in their coverage at the moment. EverSince 02:50, 23 December 2006 (UTC) p.s. i've added a subheading that wasn't there before, to try to clarify the discussion, I hope this is OK
However much you don't like anti-psychotics, without them, labotomies would have taken longer to reduce to their current levels. Supposed 21:58, 28 August 2007 (UTC)


This article is a bit chaotic but I've added a few things and hopefully cleared up the most obvious red herrings.

I'll try and spend some time to organise and reference it a little better in the near future. - Vaughan 12:25, 1 Aug 2003 (UTC)

Minor change from 'The term antipsychotic is applied to any drug used to treat psychotic disorders...' to 'The term antipsychotic is applied to a group of drugs used to treat psychotic disorders...' as (for example) benzos and antidepressants can be used to treat psychotic episodes, however these are not considered to be antipsychotics.

- Vaughan 12:30, 1 Aug 2003 (UTC)

[edit] Terminology

It is my understanding that neuroleptic was initially a French term and that its specific literal meaning was related to the tendency to cause movement disorders. As I'm going on memory of an article I don't have in front of me ; I'm not changing anything right now.71.214.6.129 06:33, 19 November 2006 (UTC)

The alternate term major tranquillizer is more accurate as that is the mechanism by which the drug works. There is no drug on earth with "anti-psychotic" properties. The term is a complete misnomer. Francesca Allan of MindFreedomBC 03:35, 2 January 2006 (UTC)

She's right. There are no drugs that cure psychotic individuals of their ailments. Instead Major Tranquilizers are used to majorly tranquilize the dangerous, the disruptive and plain ol' nutjobs who might be a risk to themselves and to others.

She is in fact quite wrong, and you are even more incorrect. Perhaps you should research a bit more before you say things, especially if you plan to hide behind an anonymous identity. Antipsychotics are drugs to relieve the effects of psychosis, and your diagnosis to people with problems as 'plain ol' nutjobs' is rather hasty, not to mention rude. Major tranquilizers are used in the treatment of berserk and Aggressive, violent people, AND psychosis. not all people who are experiencing symptoms typical to those of psychosis are violent, and major tranquilizers certainly not used to cure people of EITHER condition, they are typically used as a method of either subduing the patient or inducing sleep, as well as helping chemical inbalances in the brain. Perhaps you should think before you use such rude terminology, you make people experiencing psychosis sound like serial killers.--Neur0X .talk 01:23, 13 August 2006 (UTC)

[Well, Neur0X, saying that antipsychotics help to relieve humans of their chemical imbalance is a nasty smite against evolution. There are many ways that evolution has betrayed the human societal ideal. After all, why let insects act like animals with their chemical imbalances and destroy our crops? The chemical imbalance you describe is merely a euphemism to explain why the diagnosed can't easily fit into the culture of the western world. However, the western world is either far too stupid or far too shrewd, at least in this point in history, to provide resolution to its ill members.

<PARANOID_CONSPIRACY> Allow me to begin to explain how capitalism has influenced this whole idea of mental illness and finding its cure. Imagine a world where bipolar and schizophrenia were totally eradicated. The whole paradigm of the hospital would shift dramatically. The western world would also likely have a means to cure the cause of drug abuse, and the world would be dramatically different, affecting everything from the economy to street life. This is not to say that current lack of scientific knowledge isn't the cause of not having a cure, but I do believe that there would be great disaster if the cure were to envelop society too quickly.

And I'll go on another tangent - if you developed a cure for mental illness, would you want to sign the intellectual property rights over to large pharmaceutical companies that take credit for a discovery? After all, we more closely associate the development of Heroin to Bayer than to its actual inventor.

But think of how long it has taken science to come up with the glutamate theory of schizophrenia. We have known the effects PCP has had on glutamate for decades. But it has taken many more decades for them to have come up with this theory. I believe there is deliberation going on in terms of furthering research in this area. </<PARANOID_CONSPIRACY>] --cruisefx

"Antipsychotic" is a marketing term. These drugs make patients easier to control. They are tranquillizers, which work to suppress the central nervous system. They are not reserved for the "berserk" and "aggressive." Atypical antipsychotics are now being prescribed for all kinds of mental "diseases," including those of infants and toddlers. 208.181.100.56 (talk) 22:18, 1 January 2008 (UTC)

Ouch, suppressing the CNS could lead to serious medical problems and death. Antipsychotics work by blocking particular dopamine receptors in certain areas of the brain, with then leads to a decrease in delusions, hallucionations and helps restore normal thinking. They were called tranquilizers as the person who was suffering from postive symptoms of schizoprenia or mania would be able to regain functionality and become "calm". Please back up your statments with refernces, as far as I'm aware there are no psychitropics that have FDA indications or are used off-label in "infants and toddlers". edmartco 5/17/08 —Preceding unsigned comment added by Edmartco (talk • contribs) 01:04, 18 May 2008 (UTC)

[edit] Amotivation

The article on dopamine mentions that some anti-psychotics that affect dopamine activity can act as amotivators. Is anyone able to elaborate on this?

Look below in "Making symptoms worse / side effects".

128.151.161.49 17:34, 6 March 2006 (UTC)Iain Marcuson

The part about off-label uses for antipsychotics is incorrect. Pimozide and Haloperidol are indeed used for Tourette's Syndrome, but those are FDA approved drugs for that condition. Off-label refers to treating a disorder with a drug that is not approved for such usage, such as using an anti-seizure medication to correct a mood disorder.


One thing I notice isn’t mentioned clearly in the article is the disastrous effect some of these drugs can have on people. In 1997 I suffered a mental breakdown and had what was called a severe psychotic episode (basically due to extreme stress), I was sectioned and put in mental hospital and was put on Droperidol, paroxetine and a short course of high dose lorazepam. My symptoms from these 'anti-psychotics' became very severe. I became suicidal while in hospital and I never had been ever before. Worse, as the drugs ‘cured’ my bipolar 'depression' my reality began to slip and for a while after I was out of hospital I lost my core reality completely. I had gone from being psychotic and manic depressive to full blown schizophrenia. Eventually I began to regain reality, and have at least partly recovered but it has been a very difficult process and I don't even know if I would be alive now if it wasn’t for my families (especially my mothers) huge help.

I am probably the ultimate non-typical mental patient, until my breakdown I had been well rooted in reality for all my then 27 years. I was and am a computer scientist, I was specialising in AI and machine intelligence, I had a reasonably good knowledge of neurology and psychology, had been actively studying human consciousness for several years and was specialising in vision systems. What makes me even more untypical was that I had just made a breakthrough and was contemplating something not worth millions but many billions of dollars, and it was the stress of this this that I partly blame for the original breakdown.

The source of all my problems was that the doctors treated me like a sausage in a sausage factory, most of the people in that (uk) hospital got the same drugs as me and its obvious that its not so much the drugs fault so much as the way they were prescribed - the doctors and the system. Understandably I now have a deep fear and a certain hatred of psychiatrists because of this - just like seemingly most other mental patients. Another point not mentioned is the huge physical damage the drugs do to people, the line of emaciated half corpses that were most of the patients in that hospital reminded me unmistakably of Dachau.

I apologise for the length of this but its not easy to put things simply. Lucien86 05:58, 4 June 2006 (UTC)

[edit] English please?

As this is an encylopedic article, could we break this down into something more understanable to the common person? I mean, the article isn't in a science magazine, nor is it being presented at a science convention of some sort. It's for the common persons and the researchers. Is it possible to make this more understandable? I read through it and I'm not an expert, but that's exactly my point. Colonel Marksman 06:31, 16 December 2006 (UTC)

To be fair, this isn't the kind of topic generally looked up by anyone but a student or specialist, and as such, will find much more value in being indepth and technical the way it is, rather than simplified for your average user. More simplified explainations can be found in the various pages for specific antipsychotics, which is quite possibly where the information you're looking for or interested in is covered? ;-)

neodarkcell


Personally I agree that it could and should be more readable, which doesn't preclude depth EverSince 03:02, 23 December 2006 (UTC)

Not looked up by anyone but med students or specialists? First, specialists are well versed in the knowledge presented in this wiki and likely to find it elementary. Second, what about PATIENTS?

[edit] Move?

It seems like this would be less awkward under the title "Antipsychotics," since the article is about the class of drug, not a single thing. Night Gyr (talk/Oy) 03:51, 11 January 2007 (UTC)

[edit] External link to objectionable website

There is a link under the subheading "Side Effects" (Tardive dyskinesia) that redirects to what appears to be a pseudoscience website www.yoism.org. Although there are indeed pictures there of what appear to be something like tardive dyskinesia, viewers must sift through alot of highly opinionated non-scientific garbage to get to anything of interest. Would it be ok to remove this link? Surely there must be other sources that would do better here? I will look for some.Neurophysik 05:25, 27 February 2007 (UTC)

[edit] Indications

Are antipsychotics indicated to prevent suicide? E.g. would they be given to someone who is suicidal because of depression?--137.205.76.219 16:38, 17 March 2007 (UTC)

[edit] Criticism

this section is more or less complete crap. good prognosis in developing countries is unrelated to occurrence rates or neuroleptics, but probably the superior management that arises from being better accepted and integrated into the community. Note that the /appearance/ of schizophrenia is highly dependent on management strategies, and also note that cross cultural studies have huge methodological difficulties, and aren't that common. the basic rule for schizophrenia is that there /is/ no good treatment, only the best of a bad bunch, and I'd hate to see the hippies, anti-psychiatrists and scientologists encouraging people to abandon neuroleptics because of crank science

I've tried making an efficacy/effectiveness section instead of a criticisms section, to include the views and evidence for, as well as against, antipsychotic efficacy. It probably needs to give a fuller account of the case for efficacy, but for now I've at least added coverage of the two major guidelines recommending them. I have tried to reliably describe and source the case against, which is a bit more disparate. There are more specifics on efficacy in the section comparing typicals and atypicals. EverSince 14:52, 10 August 2007 (UTC)
Sounds a good way to make it balanced. This article needs alot of work....cheers, Casliber (talk · contribs) 15:27, 10 August 2007 (UTC)

[edit] Research / Upcoming Antipsychotics

Should there be a section describing current research and a list of drugs in the pipeline for each research/future treatment area?

[edit] cannabidiol

I've no idea where to put cannabidiol in this article. It's been shown to act as an anti-psychotic so can be described as one. However, the definition of both typical and atypical anti-psychotics describes these as prescribed drugs. I also don't know whether to call it a typical or an atypical anti-psychotic. Supposed 21:45, 28 August 2007 (UTC)

[edit] Making symptoms worse or adding side effects.

To anyone reading this - In my experience, antipsychotics will completely demolish one's sense of social anxiety, paranoia, and being in the dark. If you embrace your healthy sense of paranoia, taking these will make thinking about such things an arduous task. In addition, I used to have love for things like fire and the outdoors, but I no longer have significant feelings for them. —Preceding unsigned comment added by 69.250.158.97 (talk) 17:44, 30 May 2008 (UTC)

Also, in my comment about motivation and desire, there is a scientific study which shows that when rats are injected with antipsychotics and made to run a maze, they do several times better when they are thereafter injected with L-dopa (the bioavailable form of dopamine).

I have schizophrenia and have taken Risperdal and now Zyprexa.

This article describes the dramatic increase in synaptic dopamine bought about by release of endogenous dopamine by electrical stimulation and antipsychotic treatment, and the experiment was successfully repeated a number of times and established.

http://jpet.aspetjournals.org/cgi/content/abstract/232/2/492

Similar levels of dopamine (in the mM range) are achieved with amphetamine and can lead to disturbed sexuality. With such high levels of dopamine, serotonin usually ramps down - could this lower serotonin cause depression and guilt.

-Steve. —Preceding unsigned comment added by 131.181.251.66 (talk) 12:36, 9 October 2007 (UTC)

I've no idea, however as you're no doubt aware the article is in vitro which doesn't help Supposed (talk) 17:07, 15 April 2008 (UTC)

[edit] quetiapine, sedation and major-tranquilisers

Quetiapine is quite an effective tranquiliser at doses below 200mg. I was under the impression that quetiapine is referred to as a major-tranquiliser. I can certainly mimic some of the effects of benziadiazapines although it's not itself considered an anxiolytic. My question, is it just typical anti-psychotics that are referred to as major tranquilisers like the article says, because it appears to me that drugs like quetiapine may be even more sedating and anxiolytic in effect than some of the typical anti-psychotics. "Typical antipsychotics are also sometimes referred to as major tranquilizers, because some of them can tranquilize and sedate." Supposed (talk) 06:03, 17 April 2008 (UTC)

Problem is all the uses of labels. Major Tranquiliser is an old term applied to all antipsychotics, while benzodiazepines were minor tranquilisers. The terms aren't used much anymore. Any drug with sedating properties (suhc as quetiapine) will have some anxiolytic properties, however the term anxiolytic as such is generally restricted to drugs like Xanax (alprazolam). Hope that helps. Cheers, Casliber (talk · contribs) 06:41, 17 April 2008 (UTC)
Thanks for your response. "Major Tranquiliser is an old term applied to all antipsychotics, " hmm. Then I think we need to remove the word 'typical from the following sentence, "Typical antipsychotics are also sometimes referred to as major tranquilizers, because some of them can tranquilize and sedate." Is there anything reputable online that refers to all anti-psychotics as major tranquilers, or are you trying to say that the term is merely of historica significance, such that no anti-psychotics would be referred to as that today? Inregards to 'anxiolytic', the same paper that referred to cannabidiol as an anti-psychotic also referred to it as an anxiolytic. This is of particular signifance as in contrast to benzo's it's non addictive and illegal even on prescription. Supposed (talk) 16:02, 18 April 2008 (UTC)
RE ANXIOLYTIC, could you possibly help me clean the article up as there appears to have been an awful lot of crap added to it recently but I didn't keep an eye on it. [1] I haven't heard of cannabidiol actually inducing anxiety in people. Supposed (talk) 16:08, 18 April 2008 (UTC)