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Dr. Bob is Robert Hsiung, MD,
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Posted by Quintal on January 6, 2007, at 23:30:49
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Phillipa on January 6, 2007, at 23:14:36
> Laima someone just posted a link on seroquel in prisons and on the street sick behavior in my opinion only . I can't imagine it. But then I'm not a drug seeker. Hope this is civil. I think it's something that needs to be studied immediatedly as atypical antipsychotics are thought of as not being addictive or abused. And your earlier question. No no no to antidepressants with a needle point well made. Love Phillipa
Phillipa, I posted a similar link a while ago for us all to laugh at. I really don't think Seroquel has any serious abuse potential. As far as I can tell from those links the people are using Seroquel to treat the insomnia and jitters caused cocaine abuse, not as a pure drug of abuse in itself. Likewise in prisons a minority of people may prefer the mindless stupor of Seroquel to the boredom and frustration of being incarcerated. I have a history of substance abuse and have had no desire to abuse Seroquel. I still have nearly a full packet that I got a year ago. This is someone who managed to get abuse potential from Parnate.
http://www.dr-bob.org/babble/20070101/msgs/719973.html
As far as I can tell from the other case report the guy simply got frustrated about the doctors trying to deprive him of a med that had been very effective and stormed out in a temper saying he'd get it from his fellow prisoners who were probably using for the purposes I described above.
That's my opinion on the whole 'Seroquel abuse' issue anyway.
Q
Posted by laima on January 6, 2007, at 23:43:21
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Phillipa on January 6, 2007, at 23:14:36
I just saw that about the seroquel abuse! One of the strangest things I've heard here in a long while. I can't imagine they get high from it, maybe it does something special combined with cocaine? Of course, could most of us guessed some years back that cough syrup would end up behind the pharmacy counter due to abuse?
> Laima someone just posted a link on seroquel in prisons and on the street sick behavior in my opinion only . I can't imagine it. But then I'm not a drug seeker. Hope this is civil. I think it's something that needs to be studied immediatedly as atypical antipsychotics are thought of as not being addictive or abused. And your earlier question. No no no to antidepressants with a needle point well made. Love Phillipa
Posted by laima on January 6, 2007, at 23:46:49
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 23:18:36
Did you notice if he had a zyprexa pen?
> I certainly did and gave him a piece of my mind about prescribing antipsychotic drugs for anxiety that responds well to benzodiazepines (he was suggesting Zyprexa as a safer alternative to clonazepam and Prozac). He still maintained Zyprexa has fewer potential side effects than benzos (I'm guessing Eli Lily told him that) and discharged me, presumably because his ego was dented and he wanted to avoid any potential future injury.
>
> Q
Posted by Phillipa on January 6, 2007, at 23:47:59
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by laima on January 6, 2007, at 23:46:49
Oh I bet he did along with a notepad. Love Phillipa
Posted by laima on January 6, 2007, at 23:50:28
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by Quintal on January 6, 2007, at 23:30:49
Your take on the scenario makes a lot of sense. One can really sleep long and well on seroquel, I hear. Reminds me of wanting to oversleep when feeling really depressed and bored, wishing I was tireder.> Phillipa, I posted a similar link a while ago for us all to laugh at. I really don't think Seroquel has any serious abuse potential. As far as I can tell from those links the people are using Seroquel to treat the insomnia and jitters caused cocaine abuse, not as a pure drug of abuse in itself. Likewise in prisons a minority of people may prefer the mindless stupor of Seroquel to the boredom and frustration of being incarcerated. I have a history of substance abuse and have had no desire to abuse Seroquel. I still have nearly a full packet that I got a year ago. This is someone who managed to get abuse potential from Parnate.
>
Posted by Quintal on January 7, 2007, at 0:06:51
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by laima on January 6, 2007, at 23:46:49
>Did you notice if he had a zyprexa pen?
Yes, he did. Along with a Cipralex mouse mat, Zantac notepad and what appeared to be a Risperdal door jamb (!). Those drug companies really know how to lay on the PR with a trowel. I wonder how many (now likely diabetic, obese, neurologically damaged) ex-Zyprexa users here would relish wiping their posterior on rolls of Zyprexa toilet tissue - if only Eli Lily would be so kind?
Q
Posted by med_empowered on January 7, 2007, at 0:06:57
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by laima on January 6, 2007, at 23:50:28
thought i'd break up the string w/ a new title.
I think the whole seroquel thing is like another poster said--some people just get bored (and, I'm guessing, scared) in prison, and I imagine neuroleptics (especially sedating ones w/ low EPS) could counter that. If I recall correctly, there has long been a minority of prisoners who will feign psychosis to get a low-dose prescription of thorazine, thioridazine, etc...anything low-potency to take the edge off w/o being intolerable, like Haldol.
I think shrinks can sometimes (unintentionally) be hilarious. I remember I had a shrink try to RX Abilify right off the bat, and I kept saying "no, I don't really like neuroleptics" and she would say "its the cleanest thing we have..." so on and so forth. I looked at her for a second and saw...a shiny, new Abilify clipboard.
Posted by Klavot on January 7, 2007, at 4:23:46
In reply to atypicals, etc., posted by med_empowered on January 7, 2007, at 0:06:57
> I think shrinks can sometimes (unintentionally) be hilarious. I remember I had a shrink try to RX Abilify right off the bat, and I kept saying "no, I don't really like neuroleptics" and she would say "its the cleanest thing we have..." so on and so forth. I looked at her for a second and saw...a shiny, new Abilify clipboard.
>My pdoc has a Zyprexa picture frame on her desk, with pictures of her children in it ?!?!?!?
Klavot
Posted by SLS on January 7, 2007, at 6:57:14
In reply to atypicals, etc., posted by med_empowered on January 7, 2007, at 0:06:57
I'm surprised you haven't brought into the conversation the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.
It supports your point of view.
I don't think it proves very much more than that perphenazine is a pretty good typical antipsychotic. I didn't like it when I took it, though. I felt numb and passified. I felt like a zombie. The same was true of Thorazine and Prolixin. I have not experienced such a thing with any of the atypicals, and I have taken them all with the exception of clozapine. Not only that, but the atypicals have been more effective in producing an antidepressant effect. Zyprexa was a potent antimanic and produced great clarity of thought.
n=1
Paper versus real life.
I don't know what to make of the CATIE study. It has been scrutinized and debated, of course. If you search on Google, you will find critiques of it. I really don't think much of the design, and I think the study was to ambitious, but I'll let Google worry about that.
---------------------------------------------Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
Jeffrey A. Lieberman, M.D., T. Scott Stroup, M.D., M.P.H., Joseph P. McEvoy, M.D., Marvin S. Swartz, M.D., Robert A. Rosenheck, M.D., Diana O. Perkins, M.D., M.P.H., Richard S.E. Keefe, Ph.D., Sonia M. Davis, Dr.P.H., Clarence E. Davis, Ph.D., Barry D. Lebowitz, Ph.D., Joanne Severe, M.S., John K. Hsiao, M.D.,
for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators
Background The relative effectiveness of second-generation (atypical) antipsychotic drugs as compared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We compared a first-generation antipsychotic, perphenazine, with several newer drugs in a double-blind study.
Methods A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and randomly assigned to receive olanzapine (7.5 to 30 mg per day), perphenazine (8 to 32 mg per day), quetiapine (200 to 800 mg per day), or risperidone (1.5 to 6.0 mg per day) for up to 18 months. Ziprasidone (40 to 160 mg per day) was included after its approval by the Food and Drug Administration. The primary aim was to delineate differences in the overall effectiveness of these five treatments.
Results Overall, 74 percent of patients discontinued the study medication before 18 months (1061 of the 1432 patients who received at least one dose): 64 percent of those assigned to olanzapine, 75 percent of those assigned to perphenazine, 82 percent of those assigned to quetiapine, 74 percent of those assigned to risperidone, and 79 percent of those assigned to ziprasidone. The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine (P<0.001) or risperidone (P=0.002) group, but not in the perphenazine (P=0.021) or ziprasidone (P=0.028) group. The times to discontinuation because of intolerable side effects were similar among the groups, but the rates differed (P=0.04); olanzapine was associated with more discontinuation for weight gain or metabolic effects, and perphenazine was associated with more discontinuation for extrapyramidal effects.
Conclusions The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons. Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone. Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism.
---------------------------------------------
- Scott
Posted by ed_uk on January 7, 2007, at 7:52:47
In reply to Re: the case for neuroleptics is kind of weak, posted by linkadge on January 6, 2007, at 21:02:44
Hi Link
Althought Cogentin and other anticholinergics can often suppress acute EPS, they do not generally relieve the symptoms of TD. In fact, TD symptoms are frequently aggravated by anticholinergics.
Ed
Posted by ed_uk on January 7, 2007, at 7:58:42
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 22:38:32
>I'm believing ever more strongly that they should really think about taking some of these drugs themselves before making comments like that.
That is so true. It would be very helpful if pdocs actually tried a range a psych drugs to find out how they make them feel. If they are telling you that Risperdal only causes mild side effects (or whatever), let them try a 6mg tablet are see how it makes them feel. There was a very interesting study where a group of pdocs were given a moderate dose of droperidol, a neuroleptic. Almost all of them found it extremely unpleasant, and some had to be admitted to a psych ward for treatment after receiving a single dose. One pdoc became profoundly suicidal.
Ed
Posted by ed_uk on January 7, 2007, at 8:00:19
In reply to Re: Patient paid to accept neuroleptic depot injec » linkadge, posted by yxibow on January 6, 2007, at 22:38:40
Hi Jay
Niacin frequently causes flushing. Niacinamide (nicotinamide) is the variety of vitamin B3 which doesn't cause flushing.
Regards
Ed
Posted by ed_uk on January 7, 2007, at 8:07:36
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 23:18:36
Good afternoon Professor Quintal,
Docs in the UK would rather give you *anything* than precribe a benzo. Perhaps they'll offer you a depot next time? :)
Ed
Posted by ed_uk on January 7, 2007, at 8:10:21
In reply to Re: Patient paid to accept neuroleptic depot injec » Phillipa, posted by Quintal on January 6, 2007, at 23:30:49
I agree. Seroquel, like other APs, has no 'recreational value'.
>As far as I can tell from the other case report the guy simply got frustrated about the doctors trying to deprive him of a med that had been very effective.....
Which is understandable. This isn't 'addiction'.
Ed
Posted by ed_uk on January 7, 2007, at 8:11:56
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by laima on January 6, 2007, at 23:46:49
>Did you notice if he had a zyprexa pen?
You know, I think I have a Zyprexa pen. Providing pens is one of the only advantages of drug reps IMO!
Ed
Posted by ed_uk on January 7, 2007, at 9:07:40
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by ed_uk on January 7, 2007, at 8:11:56
Hmm, my thread is getting quite long. I like it when this happens.
Ed
Posted by laima on January 7, 2007, at 9:41:48
In reply to Re: Patient paid to accept neuroleptic depot injec, posted by ed_uk on January 7, 2007, at 9:07:40
Wasn't there something in the news last year about doctors in the US resolving to accept fewer gifts from pharmaceutical salespeople? If so, what ever happened with that? Or was that only a resolution not to accept big gifts like golf outings?
I have an ambien flashlight- I suppose it's for those times ambien's not working. Zyprexa toilet tissue sounds like a great idea- I think a zyprexa measuring tape might be handy, too. Or a scale...
Posted by linkadge on January 7, 2007, at 12:02:36
In reply to Re: Patient paid to accept neuroleptic depot injec » laima, posted by Quintal on January 6, 2007, at 22:38:32
>I did eventually take it and he refused to >believe that 5mg was making me feel spaced out >and drowsy. He also thought Zyprexa would cause >no significant impairment in driving performance >even if taken in the morning.
Wow. They just believe whatever those leaflets tell them. Ask him to go home, take 10mg of zyprexa, and then see if you remember how to butter toast.
Actually I remember an article about a psychiatrist who, had a whole paradigm shift in the way she dealt drugs, after ingesting some haldol.
Linkadge
Posted by linkadge on January 7, 2007, at 12:44:09
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by ed_uk on January 7, 2007, at 7:58:42
>Almost all of them found it extremely >unpleasant, and some had to be admitted to a >psych ward for treatment after receiving a >single dose. One pdoc became profoundly >suicidal.
The effects of the drug were probably compounded by a cumulative..."what have I been doing to my patients"
Linkadge
Posted by linkadge on January 7, 2007, at 12:47:58
In reply to Re: zyprexa pens, posted by laima on January 7, 2007, at 9:41:48
>I have an ambien flashlight- I suppose it's for >those times ambien's not working.
Good one!!
Linkadge
Posted by linkadge on January 7, 2007, at 12:48:57
In reply to Re: zyprexa pens, posted by linkadge on January 7, 2007, at 12:47:58
Or maybe when you wake up at night and can't sleep. The flashlight helps you find the drugs faster.
Linkadge
Posted by ed_uk on January 7, 2007, at 13:32:13
In reply to Re: zyprexa pens, posted by laima on January 7, 2007, at 9:41:48
>I think a zyprexa measuring tape might be handy, too. Or a scale...
How appropriate. I'll suggest it if I see a drug rep from Lilly!
Ed
Posted by Quintal on January 7, 2007, at 15:28:46
In reply to Re: Patient paid to accept neuroleptic depot injec » Quintal, posted by linkadge on January 7, 2007, at 12:02:36
>Wow. They just believe whatever those leaflets tell them. Ask him to go home, take 10mg of zyprexa, and then see if you remember how to butter toast.
I did ask him if he would take it himself and he said he would. I also asked him if he would object to a person taking 5mg Zyprexa driving the school bus his children used and he said he would have no problem with that. I can't help but wonder if I was involved in a serious accident if the fact that I was taking Zyprexa would be brought up in court? I imagine it would - it's just too irresponsible to ignore it.
>Actually I remember an article about a psychiatrist who, had a whole paradigm shift in the way she dealt drugs, after ingesting some haldol.
That's very gratifying to hear, but not really surprising.
Q
Posted by Quintal on January 7, 2007, at 16:06:28
In reply to Re: zyprexa pens » laima, posted by ed_uk on January 7, 2007, at 13:32:13
What's the most bizarre piece of promotional material anyone has seen? We've had Risperdal door jambs, Abilify cupboards, Ambien flashlights and of course the ubiquitous pens, mugs and notepads......
I've seen Xyzal clocks, Neoclarityn tissues (my GP has chronic rhinorrhea and is usually sniffling into one) and a Lustral plant pot.
Q
Posted by ed_uk on January 7, 2007, at 16:07:17
In reply to Re: Patient paid to accept neuroleptic depot injec » linkadge, posted by Quintal on January 7, 2007, at 15:28:46
>I did ask him if he would take it himself and he said he would.
........but I assume he never has!
>I also asked him if he would object to a person taking 5mg Zyprexa driving the school bus his children used and he said he would have no problem with that.
He sounds irresponsible.
Ed
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