User talk:Dr CareBear

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Welcome!

Hello, Dr CareBear, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful:

I hope you enjoy editing here and being a Wikipedian! Please sign your name on talk pages using four tildes (~~~~); this will automatically produce your name and the date. If you need help, check out Wikipedia:Questions, ask me on my talk page, or ask your question and then place {{helpme}} before the question on your talk page. Again, welcome!  David Ruben Talk 10:03, 2 June 2007 (UTC)

Given your username and initial contributions, you may like to join editors interested in medical topics at: WP:CLINMED and its talk page, our Doctor's Mess, of WT:CLINMED

Also the pharmacology project is at WP:PHARM.

I would point out that this is an encylopaedia with a knowledgebase across the articles, so each drug need not duplicate information summarised and discussed else where. Hence each tetracycline antibiotic need not set out in full the indications and side-effects unless notably different from tetracycline antibiotics as a whole. Likewise each neuroleptic article need not repeat the list of side effects, if it is already noted shares those of the group :-) David Ruben Talk 10:03, 2 June 2007 (UTC)

Thank you for the warm welcome. I expect Wikipedia to be a great asset to researchers on the Internet. Hopefully a lot of professionals as well as students will get involved in this immense undertaking of Wikipedia.

There is a lot of room for new articles to be added to the encyclopedia as well as more details to be added to the articles. I would like to see more articles on biochemistry. Many biological substances synthesized in the body have no articles for them in Wikipedia. Someone needs to recruit biochemists to produce articles. As and example there is no article on the biochemical substance of Putrecine.

Perhaps someone should make an article on the subject of side effects for Phenothiazines for instance so the side effects can be removed from the articles entirely and placed on a separate page so that the reader who wants to know the side effects can quickly jump to a special article entitled: “Side Effects of Phenothiazines”. But I have not yet learned to create a new article yet. I am just getting started. I am a busy man but I did enjoy my Wikipedia experince. I would like to do this more when I have more time. Dr CareBear 11:37, 2 June 2007 (UTC)

Contents

[edit] Suggestion

Having looked at some of the edits you've made to phenothiazine articles, might I suggest the following: verifiability and sourcing are vital on Wikipedia. Akathisia is a very real side effect which undoubtedly leads some people to stop the drug. What is needed is a source detailing, say, the incidence of akathisia, its impact on quality of life, the number of people who discontinue neuroleptics because of it, etc. Just writing that a phenothiazine is a "highly toxic drug" or that a side effect is "agonizing", without a source, may be true (or at least a valid opinion), but on Wikipedia these things need to be sourced. Please let me know if you have any questions about this. MastCell Talk 02:32, 6 June 2007 (UTC)

Also, if you have suggestions for such a source but are not sure how to cite it, let me know - I can help. MastCell Talk 02:33, 6 June 2007 (UTC)
I am new to Wikipedia and I do not know how to use certain features of Wikipedia. I do not know how to add a reverence yet. Can you explain?

Dr CareBear 02:46, 6 June 2007 (UTC)

A reference may easily be added in footnote format by placing it between a <ref> tag and a </ref> tag, and adding the following section near the bottom of the article, before categories and stub templates:
==References==
<references/>
Many articles already have such sections, which may also be called "Notes" or "Footnotes".
In order to cite MEDLINE-indexed periodicals, you may use this tool. Simply input the article's PMID and it will output a complete reference which may be pasted into the article. You may find out more about referencing in Wikipedia by following these links. Also, please always bear in mind that sources must be reliable in order to be accepted in Wikipedia. Fvasconcellos (t·c) 03:14, 6 June 2007 (UTC)

[edit] Haloperidol - Adverse Effects

Hi there. Wouldn't you rather create this article in your userspace? This would give you the chance to expand it and add references before making it available in the encyclopedia itself. Also, please stop prefixing akathisia with "agonizing"—as I explained [1], anyone who clicks on the akathisia link will find out, in that article, how incredibly unpleasant it is. Have a look at the pimozide article—it explains clearly and impartially about akathisia and other side effects. Fvasconcellos (t·c) 14:27, 6 June 2007 (UTC)

Thank you for pointing out the akathisia editing on pimozide.

Dr CareBear 12:45, 8 June 2007 (UTC)

[edit] Vandalism accusations

redacted. Was a new user then. Still am. See history if anyone is interested.

[edit] Sockpuppetry case

lenghthy material on Sockpuppetry redacted. If anyone is interested see the History because it is still there.

[edit] Sources

User:Dr CareBear, please provide verifiable sources for your edits, as some are factually utterly incorrect. Here you insert a paragraph about the side-effects of acetylcholinesterase inhibitors. However, phenothiazines not only are not acetylcholinesterase inhibitors, but have anticholinergic properties rather than pro-cholinergic properties. It would be easier to keep utterly incorrect information out of the article if you could properly source your edits. This is not a new problem and you're skirting an indefinite block for disruption at the moment. MastCell Talk 03:26, 26 June 2007 (UTC)

For my reply see your talk page. For anyone who is scrutinizing what I have added and wants to agree with MastCell you should see his Talk page for how I provided proof that MastCell is the one that is mistaken not I and how he is being disruptive and hostile to new Wikipedia contributers. I am not "POV-pushing" which means adding my own personal views. I am providing factual information to the article of phenothiazine to increase its informative value and extend the knowledge base of Wikipedia. MastCell is the one that is in error not I. MastCell does not know the difference between anticholonerigic blocking and anticholonergic which is typical of mental health professionals with little biochemistry training. See MastCell's Talk page for an abstract from PubMed that Phenothiazine Insecticides do inhibit acetylcholinesterase. That is what anticholonergic blocking is. This is not the same as blocking acetylcholine receptors which is anticholoneric. MastCell is confused and I have provided proof on his talk page that Phenothiazine Insecticides do inhibit acetylcholinesterase and that MastCell's statements are incorrect. He is confused.

Dr CareBear 05:19, 26 June 2007 (UTC)

[edit] Structures of drugs

Hi there. I'm certainly not that educated in the chemistry of drugs, but I'll try to help you. Let's take these one at a time:

  • The main functional group in risperidone is the simple aromatic ring benzisoxazole. In the structure of risperidone, benzisoxazole is the group with the fluorine attached to it. As far as I know, risperidone was developed with the structures of lenperone and benperidol, two butyrophenones ("typical" antipsychotics), as a basis.[2]
  • Clozapine, olanzapine, quetiapine and zotepine have similar structures, based on a seven-membered heterocycle with two other rings bound to it:
    • Clozapine is a dibenzodiazepine: a diazepine ring (follow the link for more) with two benzene rings fused to it. One of the benzene rings also has a chlorine atom bound.
    • In olanzapine, the ring is a thienobenzodiazepine: diazepine with a benzene fused to one side and a thiophene bound to the other. You can find out more on the structure of olanzapine, and how it is important to olanzapine's actions, here.
    • Quetiapine is a dibenzothiazepine. The ring is similar to the one in clozapine, but one of the nitrogens is replaced with a sulfur atom.
    • Zotepine is a dibenzothiepin. The ring is also similar to that of clozapine, including the presence of chlorine, but instead of two nitrogen atoms in the center ring, there is one sulfur atom.

I hope that was helpful. Fvasconcellos (t·c) 14:34, 2 July 2007 (UTC)

Thank you for the information and taking the time to reply. Dr CareBear 11:13, 5 July 2007 (UTC)

[edit] Opiates and akasthisia

Thanks for the info. Of course! I should have realsied the neurological link but brains were never my speciality (I'm an RGN). I'm looking further into this and if anything interesting comes along I'll let you know. Plutonium27 14:30, 4 July 2007 (UTC)


I am glad you found the info helful. If you also find anything new please let me know. Dr CareBear 11:15, 5 July 2007 (UTC)

[edit] Casliber Talk

Can you look at the language I have used with some of the sentences i've left - this is what I mean about encyclopedic tone. cheers, Casliber (talk · contribs) 03:01, 9 July 2007 (UTC)

If you are an expert at writing in "encyclopedic tone" then by all means rephrase rather then simply removing. Dr CareBear 03:07, 9 July 2007 (UTC)

Re suicide attempts - this is why I left the phrase in. In general we like to have cites for controversial facts, saying anything can make someone suicidal is controversial. Yes, antidepressants may make people agitated but a helluva lot of people find them very helpful or even life-saving. Yes it is important to mention but to mention poeple leaping out of cars is unnecessary.cheers, Casliber (talk · contribs) 04:39, 9 July 2007 (UTC)
Regarding akithisia - it is much more common that agitation that makes people run away from the ER is a result of psychosis rather than side effects in those who are psychotic - it is mostly seen in people who aren't acutely psychotic or who have no history of psychosis.cheers, Casliber (talk · contribs) 04:39, 9 July 2007 (UTC)
You clearly have very strong and emotional feelings about psychatric medications and are trying to contribute and that's great (and you're certainly communicating alot more than when you first started), just need to be a bit more measured in opinions. cheers, Casliber (talk · contribs) 04:39, 9 July 2007 (UTC)

The relationship of akathisia with suicidality and depersonalization among patients with schizophrenia.

Cem Atbasoglu E, Schultz SK, Andreasen NC.

Department of Psychiatry, Ankara University, Ankara, Turkey. atbasoglu@superonline.com

An association of suicidality and depersonalization with akathisia has been reported, but it is not clear whether these phenomena are specific to akathisia or are nonspecific manifestations of distress. The authors used the Barnes Akathisia Rating Scale, Brief Psychiatric Rating Scale, and Hamilton Rating Scale for Depression (Ham-D) to examine the relationships between suicidality, depersonalization, dysphoria, and akathisia in 68 patients with schizophrenia or schizophreniform disorder. Akathisia was associated with higher scores on the Ham-D ratings of suicidality, depersonalization, and agitation. In a logistic regression model, depressive mood and subjective awareness of akathisia appeared to be the only predictors of suicidality and depersonalization, respectively. These findings support the association between akathisia and both suicidality and depersonalization. However, these symptoms appear to be nonspecific responses to accompanying depressive mood and the subjective awareness of the akathisia syndrome, respectively.

PMID: 11514639 [PubMed - indexed for MEDLINE] Dr CareBear 11:20, 9 July 2007 (UTC)

Regarding akathisia and suicidality, please take a look at the list of references that I left on the akathisia talk page. A careful reading of the above abstract, which you cited, suggests that depressive mood, not akathisia, is associated with suicidality ("Depressive mood and subjective awareness of akathisia appeared to be the only predictors of suicidality and depersonalization, respectively.") The akathisia association is with depersonalization, not suicidality.
In general, there are a number of case reports and case series of suicide associated with akathisia (see the list on the akathisia talk page above), but the largest review I could find (PMID 15358982) did not find an association between akathisia and suicide. Admittedly, this question has still not been comprehensively studied. MastCell Talk 16:45, 9 July 2007 (UTC)

Perhaps what needs to be done is determining how many people these drugs make suicidal not how many actually attempt suicide. I am quite certain that all people taking these drugs feel worse then they did previously to taking them which is why so many patients refuse to take them. Also I am quite certain that many patients pretend to take them and put the drugs in the toilet just so they can avoid the ramifications of admitting they are not taking them. If it can be said that dopamine agonists which are street drugs make you "high" (euphoric) then it can equily be said that dopamine antagonists (antipsychotic drugs) will make you feel "low" (dysphoric). If it can be said that street drugs of abuse make a person "feel good" then it can equilly be said that antipsychotic make a person feel very bad like life is not worth living. Please read this article if you want to understand why dopamine antagonists which are antipsychotic drugs make people feel like "sh*t" and that life is not worth living when on them. Reward Deficiency Syndrom Dr CareBear 02:23, 10 July 2007 (UTC)

Dear Dr Carebear - finding references is good but the next issue is what assumptions to make of them. Rating scales are not a terribly good substitute for a clinical history taken by a clinician. What a patient may call 'akathisia' may be a range of things from agitation from undermedicated psychosis or post-psychotic depression as well as a true akathisia from medication. Thus the link between side effects and suicidality is unclear. furthermore the paper you cite states exactly this in the fist sentence above - so to quote a link from this paper is incorrect.cheers, Casliber (talk · contribs) 20:08, 9 July 2007 (UTC)

Did you know that exposure to insecticides like Organophosphates and Carbomates and Phenothiazine will cause a person to be "agitated". I am quite certain that people who have acute insecticide exposure are treated with antipsychotics and I know that people are not tested for insecticide exposure.

Richard M. Restak MD described the symptoms of exposure to insecticides such as these as follows:

In the section on neurotransmitters we mentioned another class of neurotoxins, inhibitors of the enzyme acetylcholinesterase, which breaks down the neurotransmitter acetylcholine. Many pesticides are designed to attack the nervous system of insects by altering the breakdown of acetylcholine. Not surprisingly, these agents also act on our brains and nervous systems to produce symptoms like weakness, difficulty in breathing, visual disturbances, and in some cases explosive violence. With low rates of exposure the problems are more subtle, a prevailing sense of tension, disturbed sleep, restlessness, chronic anxiety, and nervousness when standing in lines. On page 121 of "Brainscapes" by Richard M. Restak, MD published by NY Herperion (c) 1995.

How many people are there who have been exposed to insecticides who have been pushed into the psychiatric system I wonder? Dr CareBear 02:36, 10 July 2007 (UTC)

It is a very big jump of logic (and incorrect) to call these medications insecticides. Of course they have side effects but can be life saving as well.cheers, Casliber (talk · contribs) 03:19, 10 July 2007 (UTC)

I was refering to the Phenothiazines and it is a fact that Phenothiazine is an insecticide. DuPont introduced it as an insecticide in 1935. Dr CareBear 03:22, 10 July 2007 (UTC)

You are getting the group phenothiazines confused with the compound of the same name. Chlorpromazine is a phenothiazine but not the phenothiazine. Many many more people have been helped by these drugs than made worse and there is plenty of scientific evidence for that. Again, I repeat that they are not without side effects and your contributions, with editing, are helpfulcheers, Casliber (talk · contribs) 03:29, 10 July 2007 (UTC)

Phenothiazine dirivative drugs are manufactured from the compound phenothiazine. The only difference is that some have an aliphatic compound attached to them and others have a piperidine or piperizine attached to the phenothiazine compound. Phenothiazine compound kills insects by disabling the acetylcholinesterase enzyme. Phenothiazine dirivative drugs also do the same thing which is why it is standard procedure to administer the anticholonergic drug Cogentin with these drugs because of there being two much acetylcholine in the nervous system because of the phenothiazine drugs so the Cogentine blocks acetylcholine receptors. Piperidine is the same substance that causes the burning inflamation from fire ant venum and piperizine is a dirivative of piperidine. That is why these drugs "set your nerves on fire". They do not call them neuroleptics for nothing. neuroleptic meaning to seize your nerves. These drugs do attack your nerves and not calm them. These drugs cause great suffering. The administerization of the drugs is medical torture and I have much experience with psychiatric patients. These drugs are not saving anybodies lives but rather causing great suffering in those who recieve them. Newer atypical antipsychotics are also including the nerve inflaming piperazine and piperidine functional groups as part of their molecular structure. Dr CareBear 02:19, 11 July 2007 (UTC)

The case against antipsychotic drugs: a 50-year record of doing more harm than good.

Whitaker R.

robert.b.whitaker@verizon.net

Although the standard of care in developed countries is to maintain schizophrenia patients on neuroleptics, this practice is not supported by the 50-year research record for the drugs. A critical review reveals that this paradigm of care worsens long-term outcomes, at least in the aggregate, and that 40% or more of all schizophrenia patients would fare better if they were not so medicated. Evidence-based care would require the selective use of antipsychotics, based on two principles: (a). no immediate neuroleptisation of first-episode patients; (b). every patient stabilized on neuroleptics should be given an opportunity to gradually withdraw from them. This model would dramatically increase recovery rates and decrease the percentage of patients who become chronically ill.

Publication Types: Review

PMID: 14728997 [PubMed - indexed for MEDLINE] Dr CareBear 02:19, 11 July 2007 (UTC)

Ahem - everyone does get a chance to come off after one episode - that is standard practice. I can see this discussion is going nowhere as we both have our fixed world views. cheers, Casliber (talk · contribs) 03:42, 11 July 2007 (UTC)

That abstract called for no immediate drugging of first episode patients and the chance to go off these drugs for even multiple episodes after being "stabilized". Dr CareBear 04:52, 11 July 2007 (UTC)

[edit] Removal of tags

Hi - regarding your mass removal of tags from ECA stack, please don't remove tags without addressing the reason they were placed. The article requires much better sourcing. If you can provide sources, that would be great (I've been meaning to work on it but have been busy elsewhere). Just removing all the tags, without addressing the fact that much of the information in the article is unsourced, isn't helpful and under some circumstances could even be considered vandalism. As you know, verifiability is key, and most of these articles need more reliable sources and less unsourced assertion. MastCell Talk 16:38, 11 July 2007 (UTC)

Hello, I wandered into the article from thermogenics. I did not know it was you who put those massive amounts of citation needed tags into the article and the messages at the top that the article is in dispute. My removing of these tags was not a personal attack on you because I did not know it was you who added the tags because I did not look into the history of who did what. I just saw that an effort was underway to dismantle an article that I was interested in and I wanted to defend the article to prevent it from being dismantled peice by peice. Like I said I did not know that it was you who put the tags into this article and me removing them was not a personal attack on you. I was once skeptical like you concerning the ECA stack and I researched this subject and discovered much more on thermogenics then just the ECA stack. I educated myself on the biochemical processes that underlie thermogenesis. I tried the ECA Stack and I can tesify that it does work. It does artificially boost your metabolism and raise body tempurature. Much of the information in all the articles are the result of people adding their own knowledge on a subject from material that they have read long ago and no longer remember from which sources they gained this knowledge. If every article was dismantled for lack of references Wikipedia would be a very shallow place to get educated on any subject. Like I said I was not making a personal attack on you just defending the article from what appeared to be an effort to dismantle it and reduce it to nothingness. See my recent addition to the thermogenics article. Under the circumstances that I removed the tags it is not vandalism because you seem to be the only one who is contesting the contents of the article. Dr CareBear 03:18, 12 July 2007 (UTC)

[edit] Schizophrenia

Your addition of the references on akathisia on schizophrenia does not have the support of other editors. Please do not keep on reinserting the same content against consensus. I'd also be careful about the three-revert rule, which may lead to blocking for fixed periods of time. JFW | T@lk 03:07, 24 August 2007 (UTC)