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Folks,
Today's POST headline in the Health section, "The
Depression Test: By screening all teens, doctors hope to identify those with
mental disorders." This reminded me of a rule we established in the Saint Es
residency program when I joined it in 1964: residents could not recommend a
treatment that was unavailable to the pt. Restated, one could not add
hopelessness to the pt's situation, a rule we needed because the
residents believed that psychoanalysts was the best treatment for nearly
all psychiatric disorders. In today's POST, it is said several times that the
screening should not be used unless treatments are available, but it is not
clear how that is established. It some parts of the Washington
metropolitan area, it is hard to imagine that we are doing more than adding
hopelessness to a situation that is already unfortunate. Ten more notes from the APA Annual meeting: 1. In the 1950s and 60s, phenothiazines were used to treat anorexia nervosa. By the 1980s, that had become rare. A study, which was supported by a grant from AstraZeneca Pharmaceuticals, used quetiapine 100-400 mg/d, for this disorder and it produced a slight weight gain within 8 weeks of a sample of 9 pts. Depression and anxiety rating scales saw improvements. 2. Some positive results from using fTMS for 1] MDD pts who are pregnant, 2] OCD pts, or 3] medication-resistant depression. 3. A number of studies, supported by Lilly, found pregabalin, 75-300 mg/d, efficacious for anxiety disorders, somatic-depressive disorder [a DSM-10 disorder], MDD, and for insomnia in GAD pts 4. Single case of pt on Li, 600 mg BID, and given an ACE inhibitor, lisinopril, found four-fold increase in Li level when lisinopril was increased from 10 mg to 20 mg. Reducing the Li to 300 mg BID got the Li back to 0.7 level. 5. A case report of Li causing NMS. Man, not on antipsychotics, prescribed 800 mg Li BID, but apparently taking more on his own, and developed rigidity, akinetic mutism, temp of 103, BP 200/118, P 110, creatine phosphokinase 14,249, and WBC 12,100. Sent to the ICU with dantrolene, he was fine within four days. 6. Despite some similarities between seasonal affective disorder and ADHD, a study of light therapy failed to help children with ADHD. 7. In a comprehensive review of venlafaxine v. desvenlafaxine, no differences as to efficaciousness or side effects could be found. 8. Polypharmacy even occurs with the champ, clozapine. A study of a ward’s prescribing found 85% of pts on clozapine also on another antipsychotic at discharge. The leading other med was oral haloperidol closely followed by aripiprazole. Despite the frequency of polypharm, there were almost no studies providing any guidance at the meeting. Two exceptions: 1] Was a study suggesting that ziprasidone added to clozapine improved executive function in people with schizophrenia. 2] The combination of clomipramine and SSRI appears to be an effective and well-tolerated strategy for highly resistant OCD patients. Neurological complications appeared in 3.0% of cases but could be pharmacological controlled. 9. Along with APA Past-President, Rod Munoz, we developed a symposium on me-too medications for the annual meeting. Me-too medications are ones that are in the same class as others, e.g., escitalopram is a me-too SSRI. Several years ago, some major medical figures were condemning the pharmaceutical development of me-too medication. Over a year ago, Carol Alter gave winning testimony before a Maryland body deciding whether to put additional hurdles in the way of prescribing olanzapine. She said the hurdles were not in the pt's interest. She questioned thinking that all anti-psychotics are alike. Last year we developed a motion that the APA [and subsequently the AMA] should champion the need for me-too medications, a motion that passed WPS’s Board of Directors and is due to go to the APA Assembly next November. The symposium was well attended and most of the comments supported our position. Historically, one of the speakers pointed out, chlorpromazine was initially a me-too antihistamine. Clomipramine was a me-too tricyclic. Many a me-too anti-epileptic has become very important in managing, mood, anxiety and pain disorders. And so forth. 10. Two major psychiatrists died just before the Annual meeting began: John Nemiah and Peter Sifereos. Roger |
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